Medical Mystery — Abnormal Abdominal Radiograph
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《新英格兰医药杂志》
A 50-year-old woman presented to the emergency department with obtundation and hypotension. She had a 1-month history of slight fever, before which she had been well. On abdominal examination, an immobile, tender, firm mass was palpated to the right of the umbilicus. Laboratory evaluation revealed a white-cell count of 17,200 per cubic millimeter, a serum glucose level of 607 mg per deciliter (33.7 mmol per liter), a blood urea nitrogen level of 70 mg per deciliter (25.0 mmol per liter), and a serum creatinine level of 4.0 mg per deciliter (354 μmol per liter). An abdominal radiograph was obtained. What is the diagnosis?
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the February 1, 2007, issue and e-mail it to everyone who submits an answer. All answers must be received by December 20.
Kumiko Tajima, M.D., Ph.D.
Masahiko Kurabayashi, M.D., Ph.D.
Gunma University Graduate School of Medicine
Gunma 371-8511, Japan
mkuraba@med.gunma-u.ac.jp
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the February 1, 2007, issue and e-mail it to everyone who submits an answer. All answers must be received by December 20.
Kumiko Tajima, M.D., Ph.D.
Masahiko Kurabayashi, M.D., Ph.D.
Gunma University Graduate School of Medicine
Gunma 371-8511, Japan
mkuraba@med.gunma-u.ac.jp