, Volume 54, Issue 3, pp 488-490
Date: 25 Nov 2008

Painless Jaundice and Bilaterally Enlarged Sub-mandibular Glands in an Elderly Man

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Case Presentation and Evolution

An otherwise robust 81-year-old Japanese-American male presented to his primary care physician for painless jaundice that was first noticed by his barber. He denied any abdominal pain, but upon further questioning reported an unintentional 15-lb weight loss over the previous year and reduced energy while exercising. He had no major co-morbidities and took only omeprazole for mild gastroesophageal reflux symptoms. He denied significant use of alcohol or tobacco and had no family history of pancreatic disorders or cancer. His physical examination was remarkable only for bilaterally enlarged sub-mandibular glands.

Notable laboratory values were serum creatinine of 1.2 mg/dl, ALT 77 IU/l, AST 69 IU/l, total bilirubin 0.6 mg/dl, alkaline phosphatase 250 IU/l, total protein 8.9 g/dl, and an erythrocyte sedimentation rate of 82 mm/h. Computed tomography revealed a 2 × 2.5 cm hypodense pancreatic head mass (Fig. 1). Endoscopic retrograde cholangiopancreatography s ...