75 years old male came to me after multiple consultation with GP, Physician, Neurophysician with complaints of severe pain over the back both lumbar region radiating to both iliac fossa for the past 1 week. Pain not responding to Voveran, subsided with Tramadol. Vitals are normal. No fever, vomiting, loose stools. Loss of appetite present. Severe pallor present, Hb -4.6 gm/dl with peripheral smear shows macrocytic hypochromic RBCs n leucocytosis. MRI Spine shows cervical n lumbar mild cord compression with osteophytes n thecal indentation (done outside).
Usg Abdomen and Ct Abdomen shows hypoechoic heterogenous lesion of size around 5 cm near the tail of the pancreas above the left suprarenal area medial to the splenic hilum, ? focal pancreatitis, adrenal mass. TC - 22,800 with predominant PMNs, ESR - 150mm/hr. Mantoux awaiting. Serum amylase, Lipase sent. Still patient complains of pain…
