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Hosaka M, Kubo T, Matsuoka T, Hasegawa T. Severe Acute Pancreatitis Rapidly Developed Into Pulmonary Edema and Diffuse Alveolar Hemorrhage Leading to Respiratory Failure: An Autopsy Case. Cureus 2023; 15:e46560. [PMID: 37933351 PMCID: PMC10625659 DOI: 10.7759/cureus.46560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Acute pancreatitis often results in life-threatening situations, making a prompt and accurate diagnosis cardinally important. To achieve these, it is crucial to correctly identify characteristic symptoms and test findings. However, when patients do not exhibit distinctive symptoms during a physician's examination, in addition to limited resources, these can become challenging. In this manuscript, we present an instructive case. A male in his twenties, who complained of generalized malaise, was admitted to our hospital. Unfortunately, however, he passed away within two days prior to undergoing detailed examinations or receiving therapeutic interventions. We performed an autopsy in order to ascertain the reasons for this outcome. The findings revealed that pulmonary edema and diffuse alveolar hemorrhage were the causative factors of his demise, with acute pancreatitis observed in the background. The occurrence of acute pancreatitis leading to death in youths is infrequent. Where could we have intervened to halt such an unfortunate course in a young individual? This patient probably had diabetic ketoacidosis and hyperlipidemia, both of which are known to be closely associated with acute pancreatitis. In retrospect, we should have noticed this point. In this case, the condition progressed too rapidly for appropriate therapeutic interventions. We believe that this case would provide educational instruction for similar situations that could arise in the future.
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Affiliation(s)
- Michiko Hosaka
- Department of Surgical Pathology, Sapporo Medical University, Sapporo, JPN
| | - Terufumi Kubo
- Department of Pathology, Sapporo Medical University, Sapporo, JPN
| | | | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, Sapporo, JPN
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Glazer DI, Cochon LR, Raja AS, Jin DX, Banks PA, Sodickson AD, Khorasani R. Prevalence of imaging findings of acute pancreatitis in emergency department patients with elevated serum lipase. Am J Emerg Med 2021; 50:10-13. [PMID: 34271230 DOI: 10.1016/j.ajem.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the association of imaging features of acute pancreatitis (AP) with the magnitude of lipase elevation in Emergency Department (ED) patients. METHODS This Institutional Review Board-approved retrospective study included 509 consecutive patients presenting from 9/1/13-8/31/15 to a large academic ED with serum lipase levels ≥3× the upper limit of normal (ULN) (≥180 U/L). Patients were excluded if they did not have imaging (n = 131) or had a history of trauma, abdominal metastases, altered mental status, or transfer from an outside hospital (n = 190); the final study population was 188 patients. Imaging exams were retrospectively evaluated, and a consensus opinion of two subspecialty-trained abdominal radiologists was used to diagnose AP. Primary outcome was presence of imaging features of AP stratified by lipase level (≥3×-10× ULN and > 10× ULN). Secondary outcome was rate of discordant consensus evaluation compared to original radiologist's report. RESULTS 25.0% of patients (47/188) had imaging features of AP. When lipase was >10× ULN (n = 94), patients were more likely to have imaging features of AP (34%) vs. those with mild elevation (16%) (p = 0.0042). There was moderately strong correlation between lipase level and presence of imaging features of AP (r = 0.48, p < 0.0001). Consensus review of CT and MRI images was discordant with the original report in 14.9% (28/188) of cases. CONCLUSION Prevalence of imaging signs of AP in an ED population with lipase ≥3× ULN undergoing imaging is low. However, the probability of imaging features of AP increases as lipase value increases.
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Affiliation(s)
- Daniel I Glazer
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America.
| | - Lailah R Cochon
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America
| | - Ali S Raja
- Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States of America
| | - David X Jin
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Peter A Banks
- Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Aaron D Sodickson
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America
| | - Ramin Khorasani
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America
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Raffee L, Kuleib S, Oteir A, Kewan T, Alawneh K, Beovich B, Williams B. Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis. Postgrad Med J 2019; 96:134-138. [PMID: 31699694 DOI: 10.1136/postgradmedj-2019-137095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication. OBJECTIVES The study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis. MATERIALS AND METHODS This was a retrospective study included patients with acute cholecystitis diagnosis, who presented to 'blinded for peer review' from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis. RESULTS A total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utility CONCLUSION: Male patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.
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Affiliation(s)
- Liqaa Raffee
- Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Samer Kuleib
- Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.,Accident and Emergency, King Abdullah University Hospital, Irbid, Jordan
| | - Alaa Oteir
- Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.,Community Emergency Health and Paramedic Practice, Monash University, Peninsula Campus, Frankston, Victoria, Australia
| | - Tariq Kewan
- Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled Alawneh
- Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Bronwyn Beovich
- Community Emergency Health and Paramedic Practice, Monash University, Peninsula Campus, Frankston, Victoria, Australia
| | - Brett Williams
- Community Emergency Health and Paramedic Practice, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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