Man 31 yo, one week ago complained of epigastric pain and vomiting.
Clinical examination he had red skin on the right thorax and atrophied muscles of right arm.
Emergent abdominal ultrasound scan showed one mass of 4cm located near the head of pancreas, at processus uncinatus which compressed duodenum..
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..cross scan and long scan this mass at the head of pancreas.)
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..cross scan and long scan this mass at the head of pancreas.)
Gastroendoscopy went down just to duodenum but nothing detected.
MSCT with CE: this mass was in retroperitoneum compressing duodenum D2,
contrast injection was slowly enhancement , but it had air in the mass ( see 4 CT with CE pictures CT1, is angiogram of right axillary artery, CT2. this mass with air inside, CT3, relation with right kidney and aorta, CT4 vascular SMA and mass).
Blood tests were no abnormal.
What is your suggestion for diagnosis ?.