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In cirrhotic patients with undifferentiated shock, early CT with emphasis in ascitic fluid density should be performed to exclude rare causes of shock such as secondary peritonitis or hemoperitoneum.
An otherwise healthy 71-year-old woman presented due to a 4-h episode of mild right-upper quadrant pain. Vital signs were normal and physical examination revealed right-upper quadrant tenderness. Complete blood count was normal, serum amylase five times elevated, and liverassociated enzymes mildly elevated. Ultrasonography revealed the presence of biliary microlithiasis, increased pancreatic volume with a marked decrease in echogenicity, and the absence of gallbladder wall thickening, pericholecystic fluid, and biliary tree dilatation. Interestingly, CT revealed a couple of ill-defined, air-containing, masslike, abscess-like lesions interposed between duodenum and pancreas along with pancreatic head enlargement and peripancreatic inflammatory changes (Figure 1).
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