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01.12.2014 | Case report | Ausgabe 1/2014 Open Access

Journal of Medical Case Reports 1/2014

Pseudopancreatitis on computed tomography in a patient with isolated blunt head trauma: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2014
Autoren:
Ah-Ling Cheng, Eddy S Lang
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-8-56) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AC interpreted the CT study and acquired further clinical information and follow-up results. AC and EL were the major contributors in writing the manuscript. Both authors read and approved the final manuscript.

Abstract

Introduction

Computed tomography is commonly used to exclude occult injuries in patients with trauma, but imaging can reveal findings that are of uncertain etiology or clinical significance. We present a case of unsuspected pancreatic abnormality in a female patient with trauma who sustained an isolated blunt head injury.

Case presentation

A 25-year-old female Caucasian patient sustained massive blunt and penetrating head trauma, secondary to a large object penetrating through the vehicle windshield. Based on the mechanism of injury and clinical evaluation, it was felt to be an isolated head injury. However, computed tomography of her abdomen revealed an occult, intra-abdominal finding of significant pancreatic enlargement and peripancreatic fluid. There was no computed tomography evidence of parenchymal pancreatic laceration. The appearance of her pancreas on computed tomography was identical to that of acute pancreatitis or low-grade pancreatic injury, but her clinical history and laboratory values were not consistent with this, hence the term ‘pseudopancreatitis’. Later surgery for organ donation confirmed diffuse pancreatic and peripancreatic edema, but no hematoma, contusion or other evidence for direct traumatic injury. This was an isolated intra-abdominal abnormality.

Conclusion

The routine use of computed tomography in patients who have sustained trauma has led to increasing detection of unexpected findings. Clinical information such as mechanism of injury and blood work, along with careful evaluation of ancillary imaging findings (or lack of), is important for the provision of an appropriate differential diagnosis. We discuss the possible mechanism and differential diagnosis of an isolated pancreatic abnormality in the setting of non-abdominal trauma, which includes shock pancreas, overhydration, traumatic pancreatic injury and pancreatitis secondary to other etiologies.

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Zusatzmaterial
Authors’ original file for figure 1
13256_2013_2703_MOESM1_ESM.tif
Authors’ original file for figure 2
13256_2013_2703_MOESM2_ESM.tiff
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