Duodenal hematoma

Middle aged male with history of alcohol abuse presented to the emergency department with sudden onset of abdominal pain. Lipase came back as 4800 IU/L (normal less than 60). Ultrasound shows large collection, and a CT scan was performed, shows fatty liver and acute interstitial pancreatitis, without evidence of necrosis.

And there is a large “mass” in the doudenum.

So we turn on spectral, and the mass is hyperdense on virtual non-contrast images, and shows no iodine uptake. This is consistent with a doudenal intramural hematoma. Patient denies any trauma, therefore this is likely spontaneous.

Over the next several days, the hematoma stayed stable in size, but patient started developing symptoms of doudenal obstruction. The hematoma was drained percutaneously, under CT guidance, with rapid clinical improvement. The drain was removed 5 days later, without complication.

Just another example of how Spectral CT can shed light on confusing clinical scenarios and make them straightforward and definitive.

Ultrasound shows large “collection”

Conventional CT: Acute pancreatitis. Fatty liver reveals a more than passing familiarity with ethanol.

Iodine overlay: No evidence of pancreatic necrosis

Conventional CT: large doudenal “mass”. This corresponds to the “collection” seen on ultrasound.

Virtual non-contrast: The mass is hyperdense.

No uptake on iodine map confirms a doudenal hematoma.

Nicely depicted on iodine overlay

Percutaneous drainage of the doudenal hematoma.