Acute hemorrhagic infarct with edema

✍ Scribed by R. Rajah; J. Young; W. F. Conway

• Publisher: Springer
• Year: 1995
• Tongue: English
• Weight: 635 KB
• Volume: 24
• Category: Article
• ISSN: 0364-2348
• DOI: 10.1007/bf00198084

✦ Synopsis

Clinical information

A 50-year-old man presented to the County Hospital with increasing abdominal pain, nausea, and vomiting, having had a history of alcohol abuse for the previous 15 years. At the time of presentation, the patient had an elevated white cell count and amylase level. Subsequent ultrasound examination revealed a diffusely swollen pancreas, particularly the head. Based on the above findings a diagnosis of acute pancreatitis was made. Further clinical, biochemical, and endoscopic examination revealed esophageal erosions, a chronic duodenal ulcer, and protein calorie malnutrition. HIV status was unknown.

Two days after presentation the patient started complaining of generalized bone pain. A bone radionuclide scintigram was performed (Fig. 1). The delayed images demonstrated multiple areas of increased activity about both knees, the left ankle, t h e left foot, and the left ulna. Frontal radiographs of the knees were obtained which showed multiple moderately defined small lytic foci within the proximal tibia and distal femur bilaterally (Fig. 2). Computed tomography (CT) of the region demonstrated multiple poorly defined areas of bone destruction, involving the cortex and medullary cavity (Fig.