(Radiology. 1999;211:79-80.)
© RSNA, 1999
Case 131
Klaus D. Hagspiel, MD,
J. Fritz Angle, MD,
David J. Spinosa, MD and
Alan H. Matsumoto, MD
1 From the Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health Sciences Center, Box 170, Charlottesville, VA 22908. Received June 24, 1998; revision requested July 10; revision received July 27; accepted October 26. Address reprint requests to K.D.H.
Index terms: Diagnosis please
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HISTORY
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A 56-year-old woman fell and fractured her right ankle. After 2 days of bed rest, she presented to an outside institution with acute onset of shortness of breath, epigastric and right upper quadrant pain radiating to the back, and severe nausea and vomiting. She was afebrile, and her other vital signs were normal. She had a long medical history of "fibromyalgia," for which she received disability benefits. She also had a history of erythema nodosum that had been clinically quiescent. One year prior to this hospitalization, a temporal artery biopsy was performed because of chronic severe headaches. The biopsy results were negative. Four-vessel cerebral angiography and brain magnetic resonance imaging were performed at that time, and the results were unremarkable. The patient has a remote history of hypertension, although her blood pressure has been normal recently without antihypertensive medications. She also has been taking tricyclic antidepressants for chronic depression. She has no history of drug abuse or clinically important abdominal trauma.
The patient was hospitalized, and a myocardial infarction was ruled out. A perfusion lung scan showed no perfusion defects, and findings of a lower extremity ultrasonographic examination were negative for deep venous thrombosis. A contrast material–enhanced computed tomographic (CT) scan of the abdomen (Figure) was obtained, and the patient was then transferred to our institution (University of Virginia Health Sciences Center) for further evaluation. Throughout her hospitalization, she was afebrile and normotensive.
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Figure 1a. (a–d) Four noncontiguous 10-mm helical CT sections of the abdomen obtained after the administration of oral and intravenous contrast material.
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Figure 1b. (a–d) Four noncontiguous 10-mm helical CT sections of the abdomen obtained after the administration of oral and intravenous contrast material.
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Figure 1c. (a–d) Four noncontiguous 10-mm helical CT sections of the abdomen obtained after the administration of oral and intravenous contrast material.
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Figure 1d. (a–d) Four noncontiguous 10-mm helical CT sections of the abdomen obtained after the administration of oral and intravenous contrast material.
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Results of laboratory tests performed at the time of admission revealed an erythrocyte sedimentation rate of 84 mm/h (normal range, 0–20 mm/h), a C-reactive protein level of 5.2 mg/dL (normal level, below 0.8 mg/dL), a serum albumin level of 3.0 g/dL (normal level, 3.5–5.0 g/dL), and a hemoglobin level of 10.0 g/dL (normal level, 12.0–16.0 g/dL), with a normal white cell and differential blood cell count. The total eosinophil count was normal. The results of liver function tests at the initial visit to the outside institution were grossly abnormal, with alanine aminotransferase and aspartate aminotransferase levels both above 400 U/L. At the patient's admission to our institution, the alanine aminotransferase level was 234 U/L (normal level, 11–66 U/L), and the aspartate aminotransferase level was normal. The alanine aminotransferase level subsequently normalized during her hospitalization. The results of an extensive serologic panel for a collagen vascular disease or an autoimmune disorder were negative. All hepatitis serologic and urine test results were normal.
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Footnotes
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E-mail the most likely diagnosis to dxplease@rsna.org (use only for submission of diagnosis). Include case number, your name (as you would want it to appear in the journal), address, phone and fax numbers. Only one case, one name, and one diagnosis per e-mail submission. Multiple diagnoses, multiple submissions, submissions without a case number will not be considered. Deadline: June 15, 1999. Answer will appear in the August issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.
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