An unusual cause for hyperamylasaemia

A 79-year-old man with an extensive previous heart history was admitted electively for investigation of weight loss and deterioration of renal function.
Whilst an inpatient he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (> 2000) and deranged liver function tests. A non-contrast CT scan was done.
What is the diagnosis ?

Dr Vasileios Galanakis

Answer:

  • Due to the close anatomical proximity between the gastroduodenal artery and the common bile duct, an aneurysm or a sealed hematoma can result in extrinsic bile duct pressure leading to obstructive jaundice and hyperamylasaemia.

  • Efstratios Stratos

    Can you give us a hint as to where to focus on the CT?

  • Vasileios Galanakis

    There is a small round high density in the RUQ and a larger surrounding it, which is less dense. The interesting is not the actual lesion but the consequence of that lesion..