Subject(s)
Esophageal and Gastric Varices/diagnosis , Esophageal and Gastric Varices/etiology , Liver Cirrhosis/complications , Platelet Count , Adolescent , Adult , Biomarkers/blood , Cross-Sectional Studies , Female , Gastrointestinal Hemorrhage/etiology , Humans , Hypertension, Portal/etiology , Male , Middle Aged , Pilot Projects , Predictive Value of Tests , Young AdultABSTRACT
Giant-cell hepatitis (GCH) is characterized by parenchymal inflammation with formation of large multinucleated hepatocytes in response to a variety of insults to the liver. Although it is commonly described in neonates, it rarely occurs in adults. Here we report a case of GCH because of herbal medicine intake.
ABSTRACT
CONTEXT: Pancreatico-pleural fistula is rare complication of chronic or acute pancreatitis. Previous studies have reported imaging features and various management options of this condition including conservative/medical management, endoscopic treatments and surgery.This article reviews the myriad of imaging appearances of this condition in multimodality imaging and different strategies for the successful management in a short case series. METHODS: After obtaining the institutional ethics committee approval, retrospective review of the medical records of five patients of pancreatico-pleural fistulae who were diagnosed and successfully managed in our hospital in 2012 and 2013 was done. Follow up with out patient records of these patients was also included.Findings were compared with the current available literature on this entity. RESULTS AND DISCUSSION: Pancreatico-pleural fistulae presents with massive pleural effusion.A high index of suspicion is essential for accurate diagnosis. Demonstration of the fistulous tracts requires cross sectional imaging with contrast enhanced CT being most commonly used and affords accurate diagnosis. MRI demonstrates the tracts and ductal disruptions with greater detail and are helpful in confirming the CT findings. Endoscopic ultrasound and ERCP also offer potential of diagnosis, although being technically demanding and invasive is reserved for interventions. Management of these conditions should be initially conservative with endoscopic stenting being offered in selected cases with favourable anatomy and not responding to conservative management. Surgery is reserved for cases not responding to conservative and endoscopic management. CONCLUSION: In conclusion this case series highlights the clinical and imaging spectrum of pancreatico-pleural fistulae and provides insight into the different management strategies that can be adopted for this condition.
Subject(s)
Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/etiology , Aortic Valve , Endocarditis/complications , Mesenteric Artery, Superior/diagnostic imaging , Tomography, X-Ray Computed , Aneurysm, Infected/surgery , Aortic Valve/surgery , Diabetes Mellitus, Type 2/complications , Digestive System Surgical Procedures , Endocarditis/microbiology , Endocarditis/surgery , Heart Valve Prosthesis Implantation , Humans , Intestine, Small/blood supply , Intestine, Small/surgery , Laparotomy , Ligation , Male , Mesenteric Artery, Superior/surgery , Middle Aged , Streptococcal Infections , Viridans StreptococciSubject(s)
Colitis, Ulcerative , Lung Diseases , Lung/diagnostic imaging , Nocardia Infections , Nocardia asteroides , Superinfection , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Aged , Anti-Infective Agents/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Colitis, Ulcerative/complications , Colitis, Ulcerative/drug therapy , Contrast Media , Fever , Humans , Lung Diseases/diagnosis , Lung Diseases/drug therapy , Lung Diseases/microbiology , Male , Nocardia Infections/diagnosis , Nocardia Infections/drug therapy , Nocardia Infections/microbiology , Nocardia asteroides/drug effects , Nocardia asteroides/isolation & purification , Prednisolone/administration & dosage , Prednisolone/adverse effects , Radiography , Superinfection/diagnosis , Superinfection/drug therapy , Superinfection/microbiology , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
A 2-y-old girl presented with recurrent abdominal pain and hematemesis. The patient was diagnosed to have chronic calcific pancreatitis complicated by pseudocyst of the head of pancreas and pseudo-aneurysm of the common hepatic artery. Diagnosis was made using abdominal ultrasonography and CT angiography. The rarity of the presentation of pseudocyst with pseudo-aneurysm formation in a pediatric patient is noted. The pseudo-aneurysm was treated by embolization of the artery and the pain being refractory to analgesics was managed by celiac plexus blockade.
Subject(s)
Aneurysm, False/diagnosis , Hepatic Artery/pathology , Pancreatic Pseudocyst/diagnosis , Pancreatitis, Chronic/diagnosis , Aneurysm, False/complications , Child, Preschool , Female , Hematemesis/etiology , Humans , Pancreatic Pseudocyst/complications , Pancreatitis, Chronic/complicationsABSTRACT
A 16-year-old female was treated with pegylated-interferon (PEG-IFN) alfa (a)-2b and ribavirin combination therapy for chronic hepatitis C virus (HCV) infection. She attained rapid virological response. She presented with diabetic ketoacidosis after 41 weeks of therapy. Anti-glutamic acid decarboxylase antibodies and islet cell antibodies were negative. Her fasting serum C-peptide level was <0.1 ng/mL, and the treatment course was completed. This case underlines the importance of periodic plasma glucose monitoring in patients during and after PEG-IFN and ribavirin therapy.
