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Hepatic Cyst: An Unusual Suspect of Syncope
The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064878/ https://www.ncbi.nlm.nih.gov/pubmed/32181027 http://dx.doi.org/10.1155/2020/1659718 |
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author | Choudhry, Mohammad K. Xiong, Bei Anandaraj, Antony Trillo, John |
author_facet | Choudhry, Mohammad K. Xiong, Bei Anandaraj, Antony Trillo, John |
author_sort | Choudhry, Mohammad K. |
collection | PubMed |
description | The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient's course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson's capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient's pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts. |
format | Online Article Text |
id | pubmed-7064878 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-70648782020-03-16 Hepatic Cyst: An Unusual Suspect of Syncope Choudhry, Mohammad K. Xiong, Bei Anandaraj, Antony Trillo, John Case Reports Hepatol Case Report The patient is a 75-year-old man with history of diabetes and hypertension who presented with syncope after experiencing sharp, 10/10 right flank and abdominal pain worsening over three weeks associated with decreased appetite. Physical examination revealed hepatomegaly and right lower quadrant (RUQ) tenderness, negative for peritoneal signs. Bloodwork showed leukocytosis (13 K/mcl), alkaline phosphatase (141 U/L), total bilirubin (2.0 mg/dL), and gamma-glutamyl transferase (172 U/L). Computed Tomography (CT) revealed multiple hepatic cysts with the largest measuring 17 × 14 × 18 cm (Figure 1). Parenteral opiates provided minimal relief. Cardiac and neurologic etiologies of syncope were ruled out. The patient's course was complicated by opioid-induced delirium as his abdominal pain progressively worsened despite escalating doses of parenteral and oral analgesics. Gastroenterology and interventional radiology consulted to evaluate for Glisson's capsular stretch. Therapeutic aspiration yielded 2.5 L of serous fluid, which alleviated the patient's pain. Cytology was negative for malignancy. Opiates were titrated down. Repeat CT (Figure 2) showed cysts that were significantly reduced in size. The patient showed complete resolution of symptoms and was subsequently discharged. We present a rare case of a large hepatic cyst causing syncope. In the appropriate clinical setting, syncope with RUQ tenderness and hepatomegaly should raise the index of suspicion for hepatic cysts. Hindawi 2020-02-28 /pmc/articles/PMC7064878/ /pubmed/32181027 http://dx.doi.org/10.1155/2020/1659718 Text en Copyright © 2020 Mohammad K. Choudhry et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Choudhry, Mohammad K. Xiong, Bei Anandaraj, Antony Trillo, John Hepatic Cyst: An Unusual Suspect of Syncope |
title | Hepatic Cyst: An Unusual Suspect of Syncope |
title_full | Hepatic Cyst: An Unusual Suspect of Syncope |
title_fullStr | Hepatic Cyst: An Unusual Suspect of Syncope |
title_full_unstemmed | Hepatic Cyst: An Unusual Suspect of Syncope |
title_short | Hepatic Cyst: An Unusual Suspect of Syncope |
title_sort | hepatic cyst: an unusual suspect of syncope |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064878/ https://www.ncbi.nlm.nih.gov/pubmed/32181027 http://dx.doi.org/10.1155/2020/1659718 |
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