CASE 244: AVM and MESENTERIC PANNICULATIS, Dr PHAN THANH HAI, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 31 yo, one week ago complained  of epigastric pain and vomiting.

Clinical examination he had red skin on the right thorax and atrophied muscles of right arm.

Emergent abdominal ultrasound scan showed  one mass of 4cm located near the head of pancreas, at processus uncinatus which  compressed duodenum..
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..crossed scan and longitudinal scan of this mass at the head of pancreas.)

Gastroendoscopy went down just to duodenum but nothing detected.

MSCT with CE: this mass was in retroperitoneum compressing duodenum D2,

contrast injection was slowly enhancement , but it had air in the  mass ( see 4 CT  with CE pictures CT1, is angiogram of right axillary artery, CT2. this mass with air inside, CT3, relation with right kidney and aorta, CT4 vascular SMA and mass).

Blood tests were no abnormal.

What is your suggestion for diagnosis ?.

Operation laparotomy for  biopsy this tumor  and  bypass anatomosis ; this tumor was  covered SMA then  cannot remove.
Microscopy is  fibrosis, no  cancer cell detection.

It is a fibrosis mesenteric case.
 

Discussion: this 31 yo patient, vomitting at the clinical onset,     due to  obstruction  of upper  GI tract . Ultrasound and  CT showed  the mass  near  the processus uncinatus of  pancreas  and   SMA encasement .

Operation cannot  remove  this tumor   because  it  fixed  to superior  mesenteric artery, biopsy  this mass  with report   no cancer cell,only  fibrosis  tissue suggesting a  pseudotumor like  mesenteric  panniculatis. It is  rare case   response with  corticoid  treatment   or  with  colchicine.

REFERENCE

case  of mesenteric panniculatis.