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A Case of the Week

Case 17

An eighty eight-year-old female came to our hospital for fever, slight abdominal pain and appetite loss. She lived alone and was able to make a life by herself. Laboratory test: white blood cells (WBC) 19100/ mm3 ; CRP 21.26 mg/dl; neutophils 80.7 % (40-71); Total protein 6.6 g/dL; Albumin 1.1 g/dL; AST 131 U/L; ALT 129 U/L; ALP 633 U/L; Creatinin 1.89 mg/dL; e GFR 19.7 ml/min/1.73m2 ; Total bilirubin 0.47 mg/dL; IgG 2528 mg/dL (861-1747): Ca 11.4 mg/dL (8.7-10.49) Because non-enhanced CT showed the suspicious cholecystitis, she received central venous catheter via right subclavian vein for drip infusion of high calorie solution and antibiotics. Contrast enhanced CT was not conducted because of low value of eGFR. Day 1 suspicious cholecystitis was suspected on non-enhanced CT but the important finding was overlooked at that time. The overlooking finding was eventually found out on non-enhanced CT of Day 17. We present both CTs on Day 1 and on Day 17. Can you identify the active lesion ?

What is the appropriate imaging diagnosis on CT ?

1.Digestive organ perforation

2.Gastrointestinal stromal tumor

3.Duodenum diverticulitis

4.Retroperitoneal abscess

5.Pancreatitis


2016.8.3



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