History

A 40-year-old woman presented to the outpatient department of our hospital with a 2-year history of abdominal pain, which had worsened in the past few days. There were no other constitutional symptoms; in particular, there was no weight loss or loss of appetite. The serum amylase and serum lipase levels were always within normal limits, even during the current episode. There was no history of pancreatitis, alcohol abuse, drug use, or trauma. The patient was evaluated at an outside clinic 2 years ago and underwent imaging, including US and dedicated pancreatic CT, which revealed a complex multiseptated noncalcified pancreatic cystic lesion. After CT, the patient underwent endoscopic US, which showed the lesion was suspected to be an infected parasitic cyst; fine-needle aspiration and cytology were not attempted due to the risk of iatrogenic rupture. The patient was advised to undergo surgical resection but declined the procedure and was lost to follow-up for 2 years before her current visit to our facility. On clinical examination, there were no clinically important findings, aside from mild to moderate pain on deep palpation and some shifting dullness that was suggestive of ascites. The patient always remained hemodynamically stable. US-guided ascitic fluid analysis was performed, which revealed amylase levels of 869 IU/L (normal range, 4–234 IU/L). Considering prior CT and endoscopic US reports, the patient was further evaluated with a pancreatic MRI protocol for lesion characterization and to explain the new-onset abdominal pain (Figs 1, 2).

中文翻译：

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案例300

历史

一名 40 岁女性因腹痛病史 2 年来我院门诊就诊，最近几天腹痛加重。没有其他全身症状；特别是没有体重减轻或食欲不振。血清淀粉酶和血清脂肪酶水平始终在正常范围内，即使在当前发作期间也是如此。没有胰腺炎、酗酒、吸毒或外伤史。该患者 2 年前在外部诊所接受评估，并接受了影像学检查，包括超声和专用胰腺 CT，结果显示复杂的多分隔非钙化胰腺囊性病变。CT后，患者行内镜超声检查，显示病灶怀疑为感染性寄生虫囊肿；由于医源性破裂的风险，没有尝试细针抽吸和细胞学检查。该患者被建议进行手术切除，但拒绝了该手术，并且在她目前访问我们的机构之前失访了 2 年。在临床检查中，除了深部触诊轻度至中度疼痛和一些提示腹水的移动性浊音外，没有临床上重要的发现。患者始终保持血流动力学稳定。进行了 US 指导下的腹水分析，结果显示淀粉酶水平为 869 IU/L（正常范围，4-234 IU/L）。考虑到先前的 CT 和内窥镜 US 报告，该患者进一步使用胰腺 MRI 协议进行评估，以确定病变特征并解释新发腹痛（图 1、2）。