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March 30, 2020

Image challenge: unilateral scrotal swelling after acute pancreatitis of pancreas transplant graft

What caused a syncopal episode in a patient with leukocytosis and right-sided scrotal swelling?
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Gastroenterology clinical image challenge:  A 49-year-old man with a past medical history significant for type 1 diabetes mellitus complicated by end-stage renal disease, status post kidney and pancreas transplant, presented after a brief syncopal episode. He was found to have moderate severity acute graft pancreatitis based on serum lipase >10,000 IU/L and transient hypotension, tachycardia, hypoxia requiring 4 L of nasal cannula and bilateral pleural effusions on chest radiographs. The suspected etiology was trauma secondary to a fall versus ischemia in the setting of infectious diarrhea and volume depletion.

Organ failure and hemodynamic instability were responsive to intravenous fluid resuscitation. Seven days after initial presentation, the patient developed persistent leukocytosis and right-sided scrotal swelling. A computed tomography scan of the abdomen and pelvis with intravenous and oral contrast was obtained (figure).

What is the patient’s diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.

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