S3032 Hiding in Plain Sight: An Atypical Presentation of Metastatic Breast Cancer as Acute Decompensated Cirrhosis

Abstract

involving the gastric fundus. Patient was started on a Pantoprazole drip and a nasogastric tube was placed with low intermittent suctioning for gastric decompression. Endoscopy revealed friable hemorrhagic and ulcerated mucosa; biopsy returned positive for active gastritis in the absence of H.pylori. This elucidated the underlying cause to be most likely secondary to ischemic gastritis. Following multiple blood transfusions and ultimately symptom resolution, the patient was extubated and repeat endoscopy revealed an improvement in gastritis from prior examination. (Figure ) Discussion: Hepatic portal venous gas is considered an imaging manifestation of various etiologies and cannot be used as a predictor of mortality by itself. Most cases are caused by intestinal ischemia. Other causes can largely be divided into iatrogenic and non-iatrogenic such as infection, trauma, and ulceration in the former to endoscopic procedures in the latter. Our case is unique in that ischemia is relatively uncommon in stomach, particularly in patients such as this one with relatively little atherosclerotic disease. It is important to differentiate the etiology of portal venous gas due to its varied presentation from benign to life-threatening, its mortality being determined by the underlying pathology.[3030] Figure 1. CT scan of abdomen showing large amount of portal venous gas in the liver (red arrow) with pneumatosis involving the gastric fundus (white arrows). Figure 2: Endoscopy showing severe mucosal changes characterized by dusky discoloration, friability, hemorrhagic appearance and ulceration along the lesser curvature of the stomach.