【英语讨论】腹部|女性，51岁，复发性胰腺炎病史一年
医学影像英语学习群
当你学习英文时因一个人而无法交流，当你学习医学英语面临疑难困惑而无人解答时，快快加入我们。这里有一大群在积极学习英语的放射同行，有三甲医院的大教授，也有基层医院的小医生，并且每周1-5晚上都有放射同仁主持英文影像病例讨论。让分享变得快乐，让学习变得轻松；让交流变成友谊，让讨论变成收获.【申请入群请加ysl82677435】
我们相信有您的参与会更精彩！
今晚由卜梦森（红楼梦中梦）医生主持的病例
红楼梦非梦 19:59
Hi,good evening,It’s my turn to host tonight discussion.
I'm glad to meet everybody,there are my classmates and teachers,and lots of professors,today we will learn a new disease.I will introduce it to you.
Shall we begin?
兰博基昵 20:02
ok
红楼梦非梦 20:02
History:A 51-year-old woman with a 1-year history of recurrent pancreatitis presents as a transfer from an outside...
红楼梦非梦 20:03
Question:1.1Assuming the patient underwent a recent and unremarkable abdominal ultrasound exam, what is the most appropriate next imaging study to order?(noly one)
A.Contrast-enhanced CT (CECT) of the abdomen and pelvis
B.MRI of the abdomen and pelvis
C.Abdominal radiograph(s)
D.Nuclear medicine study
红楼梦非梦 20:10
First b,MR imaging, specifically MR cholangiopancreatography (MRCP), would be appropriate to look for ductal obstruction, but it is not the next best step for evaluation of acute-on-chronic pancreatitis.
红楼梦非梦 20:13
Question:2.1 What are the findings in the contrast-enhanced CT images?
A.Pancreatic pseudocyst
B.Fatty liver disease
C.Small bowel obstruction
雨涟 20:17I'd suggest you to save the original picture
from the website ，but not screenshot.
红楼梦非梦 20:20
3.1In a patient with recurrent/acute-on-chronic pancreatitis, which of the following should be included in the differential for the underlying cause?
A.Obstruction (eg, gallstone)
B.Trauma
C.Chronic alcoholism
D.Vasculitis
E.Autoimmune pancreatitis
红楼梦非梦 20:29
Trauma is a common cause of acute pancreatitis. Recurrent pancreatitis is not a sequela of trauma.
And,Approximately 5% of all chronic pancreatitis cases result from autoimmune pancreatitis (AIP). AIP can occur alone or can be associated with other autoimmune disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, or rheumatoid arthritis.
红楼梦非梦 20:30
ok,next one
方舟 20:38
irregular portal vein
红楼梦非梦 20:40
I will publish the rest of the pictures now
红楼梦非梦 20:48
WG was first described by Klinger in 1933, followed by other investigators, including Rossle in 1933, Wegener in 1936 and 1939, and Ringertz in 1947.
红楼梦非梦 20:48
WG is currently characterized as one of the ANCA-associated small vessel vasculitides. It is distinguished clinically by its predilection for affecting
the upper and lower respiratory tracts and kidneys and by the histologic presence of necrosis, granulomatous inflammation, and vasculitis.
红楼梦非梦 20:50
Most patients are white, the sex distribution is equal, and most present in the fifth decade, although the age range extends to both extremes.The clinical presentation of WG can be so diverse that the list of differential diagnoses is vast, ranging from infections (fungal, bacterial, and mycobacte rial) to other vasculitides, including Henoch Scho¨ nlein purpura, sarcoidosis, Behcet syndrome,and malignancies
红楼梦非梦 20:52
Unexplained constitutional symptoms are often part of the initial presentation. Fever and weight loss may be reported at the onset of the disease and more frequently during the course of the illness.The upper airway disease is the most common presenting feature of WG. This includes sinusitis,oral lesions (ulcer, gingivitis), otitis media, hearing loss, epistaxis, and saddle nose deformity; sinusitis is the most frequent initial presentation in about half to two thirds of patients with WG.
红楼梦非梦 20:53
Pulmonary involvement is one of the cardinal features of WG. It occurs in 45% of patients at presentation and 87% during the course of the disease.Cough, hemoptysis, and pleuritis are the most common pulmonary symptoms. The most common radiographic findings include pulmonary infiltrate (67%) and nodules (58%).
红楼梦非梦 20:54
Renal disease also may be seen as the initial presentation or during the course of the disease.Once present, renal disease may progress from asymptomatic and mild to fulminant glomerulonephritis within days or weeks, resulting in end-stage renal failure.Even with appropriate therapy, it
may lead to chronic renal insufficiency and renal failure.
红楼梦非梦 20:55
Ok,now,let's see the differential diagnosis from foregin doctors
1.Chronic pancreatitis and lung cancer/metastatic disease
2.Chronic pancreatitis and pulmonary septic emboli
3.Chronic pancreatitis and lung abscess
so we could make mistakes for Wegener granulomatosis
you can find lots of dotors will insist the respiratory system disease
There are some discussions from the author, Matthew J. Miller, MD
红楼梦非梦 20:59
The many causes and manifestations of pancreatitis have been vastly studied and well documented. Initially, the diagnosis of acute pancreatitis is made with the combination of clinical suspicion, elevated pancreatic enzymes, and ultrasound imaging. Contrast-enhanced CT imaging can be used to evaluate the extent of the disease, especially in the event of disease recurrence. Necrosis and pancreatic pseudocysts are classic CT findings of chronic pancreatitis. A patient diagnosed with chronic pancreatitis typically undergoes a workup for ductal obstruction with MRCP after other common causes have been ruled out such as alcohol ingestion, autoimmune disorders, and hypertriglyceridemia. Medium-vessel vasculitis, such as polyarteritis nodosa, can appear on the differential for patients with chronic pancreatitis and other GI diseases. The current case illustrates that Wegener granulomatosis, another vasculitic disease, can also cause pancreatic issues in rare instances.
红楼梦非梦 20:59
Wegener granulomatosis is a systemic small-vessel vasculitis which, in its most classic form, results primarily in renal and pulmonary pathology. In the kidneys, Wegener granulomatosis has been shown to cause rapidly progressive glomerulonephritis leading to chronic renal failure if left untreated. Pulmonary disease related to Wegener granulomatosis can range from upper airway symptoms such as rhinitis (often the presenting symptom) to cavitary lung nodules. Pancreatitis stemming from Wegener granulomatosis is a rare manifestation that has been reported only a few times. In those reported cases, the patients with underlying Wegener granulomatosis suffering from pancreatitis usually go undiagnosed until the clinical suspicion for Wegener granulomatosis reaches a high enough level to prompt a diagnostic workup. This typically occurs when the classic renal or pulmonary symptoms arise. The disease progression in these cases has varied greatly from remission to death due to advanced disease. This further drives home the point that a low index of suspicion and a broad differential diagnosis that includes Wegener granulomatosis is essential when treating a patient with chronic pancreatitis in which a cause has not yet been found.
红楼梦非梦 20:59
The patient in the current case suffered for approximately 2 years with recurring acute-on-chronic pancreatitis. She was exposed to multiple repeat scans and radiographs, which showed fluctuating pseudocysts and inflammatory changes. Prophylactic stenting of the pancreatic duct was also performed. It wasn’t until a chance finding of basilar lung nodules on CT imaging of the abdomen/pelvis created enough suspicion to prompt a lung biopsy, which established the diagnosis of Wegener granulomatosis. Following biopsy-proven diagnosis, the patient was placed on cyclophosphamide.
红楼梦非梦 21:02
These are my Referense
[1] Muller K, Lin JH. Orbital granulomatosis with polyangiitis (Wegener granulomatosis): clinical and pathologic findings. Arch Pathol Lab Med. 2014. 138(8): 1110-4.
[2] Dufour JF, Le GT, Cordier JF, et al. Urogenital manifestations in Wegener granulomatosis: a study of 11 cases and review of the literature. Medicine (Baltimore). 2012. 91(2): 67-74.
[3] Shafiei K, Luther E, Archie M, Gulick J, Fowler MR. Wegener granulomatosis: case report and brief literature review. J Am Board Fam Pract. 2003. 16(6): 555-9.
红楼梦非梦 21:02
Thank u,thank u everybody