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A 53 year old man was admitted with dyspnoea. Clinical examination and chest x ray (fig 1) suggested a large right sided pleural effusion. A spiral computed tomography scan of the chest was performed (fig 2).
He had a previous history of long term alcohol abuse with known chronic pancreatitis. There was no other relevant past medical history and he was not taking any regular medications.
During his hospital stay the patient developed abdominal pain. Laboratory investigations showed leucocytes of 12 000/μl, C reactive protein of 27.20 mg/dl, and haemoglobin of 10.4 g/dl. Serum α-amylase was 174 U/l and lipase 128 U/l.
What does the computed tomography scan of the chest show? What is the possible explanation for this finding?
See page 894 for answer
This case is submitted by:
Robin Spiller, Editor