An unusual structure near the porta hepatis: what's your diagnosis?

• Published in: Canadian Medical Association journal (CMAJ) 2004-10, Vol.171 (9), p.1048-1049
• Main Authors: Meneghetti, Victor, Lee, Charles, Perry, Thomas L, Andrews, Gordon
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aneurysm, Infected - complications; Aneurysm, Infected - diagnosis; Autopsy; Biopsy, Needle; Care and treatment; Case studies; Diagnosis, Differential; Disease Progression; Fatal Outcome; Humans; Immunohistochemistry; Lung diseases; Male; Mycobacterium avium - isolation & purification; Mycobacterium Infections, Nontuberculous - complications; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - drug therapy; Pancreatic Cyst - complications; Pancreatic Cyst - diagnosis; Pancreatic Cyst - pathology; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Portal System - pathology; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Renal Artery; Tomography, X-Ray Computed
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.1040318

Repeat chest CT and abdominal CT scans were performed in August, since the patient's condition had not improved. The scans revealed lung parenchymal changes consistent with M. avium-intracellulare infection and an infrarenal aortic aneurysm, but no malignant disease. A low-density mass 6 × 4 cm in diameter that contained areas of coarse calcification was observed at the inferior aspect of the head of the pancreas. The same mass had been found on a CT scan performed 4 years previously, and it had been reported as possibly representing a pancreatic pseudocyst. The patient's condition continued to decline, and he was admitted to hospital. In December 2003 a CT scan again revealed a low-density, fluid-attenuating structure 6 × 4 cm in diameter that was anterolateral to the inferior vena cava and near the porta hepatis (Fig. 1). It was interpreted as either a pancreatic pseudocyst or a lymph node compatible with disseminated M. avium-intracellulare. Despite ongoing quadruple antibiotic therapy, the patient died 12 days later.