Relevant laboratory results are shown below. Physical examination revealed scleral icterus. On admission, she was hemodynamically stable. She presented to an outside hospital and was transferred to UPMC for further evaluation. One week after her initial presentation, she developed a fever, jaundice, emesis and coca cola-colored urine. She was treated with Bactrim DS for suspected scalp cellulitis. Scleral icterus is a sign of jaundice caused by increased bilirubin levels in the body. There was a large, tender right posterior auricular lymph node. Physical examination revealed erythematous skin breakdown at the crown to the right of the midline, but no drainage expressible. She presented to her PCP with a 3-day history of inflamed scalp lesion and an enlarged lymph node. The patient is a woman is her late 30's with a history of recurrent scalp lesion. Pathology Conference Room (S-412 BST) CalendarĬontributed by Li Liu, MD, PhD and Alesia Kaplan, MD.Hematopathology/Flow Cytometry/Image Analysis.UPMC Digital Pathology Consultation Portal.Department of Pathology Research Seminars.Department of Pathology Research Day and Retreat.Anatomic Pathology and the Centers of Excellence.The authors declare that no patient data appear in this article. No JVD GI: nontender, distended, normal bowel sounds GU: no suprapubic or flank tenderness. No bruits or thyromegaly LUNGS: CTA, no wheezing CV: RRR, normal S1/S2, no gallops. The authors declare that they have followed the protocols of their work center on the publication of patient data. HEENT: Normocephalic, atraumatic, no scleral icterus or conjunctival injection, preauricular nodal enlargement noted NECK: supple, no rigidity. The authors declare that no experiments were performed on humans or animals for this study. Ethical disclosures Protection of human and animal subjects 4 ERCP treatment can be effective as a temporizing measure before surgery and can be definitive treatment for unsuitable surgical candidates. Surgery is the mainstay of therapy for Mirizzi syndrome. ![]() The Mirizzi syndrome is part of the differential diagnosis of obstructive jaundice and therefore the diagnostic approach usually begins with ultrasonography complemented by ERCP or magnetic resonance cholangiography.Ī useful classification system takes into account the presence and extent of a cholecystobiliary fistula, due to erosion of the anterior or lateral wall of the common bile duct by impacted stones. 1 The majority of the patients present the clinical triad of jaundice, fever, and right upper quadrant pain, showing in the laboratory evaluation elevations in the serum concentrations of alkaline phosphatase and bilirubin. The Mirizzi syndrome refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch of the gallbladder. 2) with subsequent patient referral to surgery (cholecystectomy plus closure of the fistula). Successful biliary decompression was performed by internal stenting ( Fig. 1), compatible with the diagnosis of Mirizzi syndrome. We performed an endoscopic retrograde cholangiopancreatography (ERCP) that clearly showed common hepatic duct compression by a large gallstone (20 mm) impacted in the cystic duct ( Fig. Abdominal ultrasound demonstrated a scleroatrophic gallbladder with cholelithiasis and an impacted large gallstone in the common bile duct with dilated common and intrahepatic bile ducts. Laboratory workup revealed leukocytosis (12.4 × 10 3 μL), elevated C-reactive protein (8.3 mg/dL) and cholestasis (bilirubin 5.4 mg/dL, alkaline phosphatase 893 U/L, gamma-glutamyl transferase 1143 U/L) with elevated liver enzymes (aspartate aminotransferase 231 U/L, alanine aminotransferase 178 U/L). Physical examination showed scleral icterus and right upper quadrant tenderness without inspiratory arrest at palpation (absent Murphy's sign). An 84-year-old woman presented with a 2-day history of jaundice, fever and abdominal pain.
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