A 71-year-old female presented with upper abdominal pain.
Serum amylase was markedly elevated. There was no history of trauma or fall. The following image of the pancreas was obtained by the physician in the emergency department.
What is the most likely diagnosis?
A. Free fluid in the peritoneal cavity – positive eFAST exam – send patient to OR for surgery to stop internal bleeding
B. Acute pancreatitis with peripancreatic fluid near the tail of the pancreas
C. Pancreatic cancer
The most likely diagnosis is acute pancreatitis.
Explanation
Ultrasound images show inhomogeneous echotexture and peripancreatic fluid (arrow) near the tail of the pancreas. Ultrasound findings along with the history are consistent with acute pancreatitis. Serum amylase was 1100 Units/Liter. Sometimes, due to regional ileus there may be excessive bowel gas and the pancreas may not be visualized on ultrasound. You may have the patient drink approximately 1 liter of plain water and scan again after few minutes and even scan with the patient upright.
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