A 62-yr-old white nonsmoking male, with no history of serious diseases, was referred to the emergency department due to increasing epigastric pain during the previous 2 days. Physical examination revealed clinical signs of peritonitis. Abdominal sonography demonstrated cholecystolithiasis and splenomegaly. Abdominal radiography showed pronounced air content of the intestinal loops. Based on these results, the diagnosis of acute biliary pancreatitis was suspected. The chest radiograph confirmed an intrathoracic mass located at the right side of the spine ( fig. 2) and abdominal computed tomography (CT) revealed massive peripancreatic exudation, cholecystolithiasis and splenomegaly. On examination of the chest CT, the intrathoracic mass was located close to the thoracic spine. It was 40620 mm in size, ovally shaped and even surfaced ( fig. 3).The patient was transferred to the intensive care unit for treatment of acute pancreatitis, and underwent an endoscopic retrograde cholangiography with papillotomy and extraction of numerous pigmentary gallstones. Laboratory signs of inflammation and cholestasis normalised during the following FIGURE 1. Peripheral blood smear taken on admission of the patient.