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Gut 2009;58:1653 doi:10.1136/gut.2009.178111
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A patient with new onset of thoracic pain, dyspnoea and weight loss

  1. G Lohr1,
  2. C Luft2,
  3. K Lenz1
  1. 1
    Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria
  2. 2
    Department of Radiology, Konventhospital Barmherzige Brueder Linz, Austria
  1. Correspondence to Dr G Lohr, Konventhospital Barmherzige Brueder, Seilerstaette 2, A-4020 Linz, Austria; gerald.lohr{at}bblinz.at

    Clinical presentation

    A 55-year-old man with a long history of recurrent alcohol-induced chronic pancreatitis was admitted to our hospital with new onset dyspnoea, epigastric and thoracic pain, and nausea. Clinical examination was in addition to pressure pain and resistance in the epigastrium normal. Laboratory results showed an elevation of inflammation markers (C-reactive protein, 9 mg/dl) and elevated liver (γ-glutamyl transferase, 324 U/l; alkaline phosphatase, 308 U/l) and pancreatic enzymes (amylase, 181 U/l; lipase, 93 U/l).

    A computed tomography scan of the abdomen and thorax was performed (figs 1–3).

    Figure 1

    Sagittal reconstruction of the abdominal and thoracic computed tomography scan.

    Figure 2

    Axial reconstruction of the abdominal and thoracic computed tomography scan.

    Figure 3

    Coronal reconstruction of the abdominal and thoracic computed tomography scan. …

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