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Barriales-Revilla L, Benites-Yshpilco L, Baltodano-Arellano R, Falcón-Quispe L, Cupe-Chacalcaje K, Cachicatari-Beltrán A, Lévano-Pachas G. [Imagen multimodal de la pericarditis constrictiva: reporte de un caso de cirrosis cardiaca]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:109-113. [PMID: 38046233 PMCID: PMC10688404 DOI: 10.47487/apcyccv.v4i3.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 12/05/2023]
Abstract
Constrictive pericarditis is a rare cause of ascites and cardiac cirrhosis. We present the case of a 36-year-old male patient with a history of cirrhosis of unknown etiology, who consulted for refractory ascites, dyspnea, and lower limb swelling. Echocardiography determined constrictive pericarditis, which was corroborated by the findings of computed tomography. The clinical and hemodynamic worsening of the patient led to an emergency pericardiectomy with satisfactory recovery. This report shows a severe clinical consequence of constrictive pericarditis, cardiac cirrhosis, which was reversible with pericardial extirpation. Multimodal imaging was essential in the diagnosis of constrictive pericarditis.
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Affiliation(s)
- Lucía Barriales-Revilla
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Lindsay Benites-Yshpilco
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Roberto Baltodano-Arellano
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru. Universidad Nacional Mayor de San Marcos Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Luis Falcón-Quispe
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Kelly Cupe-Chacalcaje
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Angela Cachicatari-Beltrán
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Gerald Lévano-Pachas
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
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Barry M, Al-Muhaidb S, Fathala A. A case report of constrictive pericarditis: a forgotten cause of refractory ascites. Radiol Case Rep 2020; 15:2565-2568. [PMID: 33082899 PMCID: PMC7550822 DOI: 10.1016/j.radcr.2020.09.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/30/2023] Open
Abstract
Constrictive pericarditis is well known but rare and commonly forgotten cause of ascites. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs and multiple vague symptoms and its insidious course. In this case report, we present, a 61-year-old male referred for liver transplantation vs transjugular intrahepatic portosystemic shunt work-up for presumptive diagnosis of nonalcoholic steatohepatitis cirrhosis and refractory ascites. Comprehensive work-up before liver transplantation including liver biopsy, liver ultrasound, and Doppler, magnetic resonance imaging was not consistent with liver cirrhosis. Echocardiographic was suggestive of constrictive pericarditis, further work-up with right heart catheterization, cardiovascular magnetic resonance and multidetector cardiac computed tomography confirmed the diagnosis of constrictive pericarditis. Patient underwent surgical pericardiectomy, he reminded stable after surgery and did not require further paracentesis and discharged in stable condition.
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Affiliation(s)
- Mohammad Barry
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Saud Al-Muhaidb
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, Cardiothoracic Radiology and Nuclear Medicine divisions, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
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Bezjak M, Kocman B, Jadrijević S, Gašparović H, Mrzljak A, Kanižaj TF, Vujanić D, Bubalo T, Mikulić D. Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report. World J Clin Cases 2019; 7:3266-3270. [PMID: 31667177 PMCID: PMC6819289 DOI: 10.12998/wjcc.v7.i20.3266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/23/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation (OLT). The broad spectrum of differential diagnosis often leads to delay in diagnosis. Therapy depends on recognition and treatment of the underlying cause. Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure. In the advanced stages of the disease, hepatic congestion leads to formation of ascites. In patients after OLT, cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.
CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis. Prior to transplantation the patient had a minimal amount of ascites. The transplant procedure and the early postoperative course were uneventful. Standard post-transplant work up failed to reveal any typical cause of refractory post-transplant ascites. The function of the graft was good. Apart from atrial fibrillation, cardiac status was normal. Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema. Ascites was still prominent. The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology. Diagnostic paracentesis was suggestive of cardiac ascites, and further cardiac evaluation showed typical signs of constrictive pericarditis. Pericardiectomy was performed followed by complete resolution of ascites. On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.
CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes. Broad differential diagnosis needs to be considered.
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Affiliation(s)
- Miran Bezjak
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Branislav Kocman
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Stipislav Jadrijević
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Hrvoje Gašparović
- Division of Cardiology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Tajana Filipec Kanižaj
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Darko Vujanić
- Division of Cardiology, Department of Internal Medicine, University Hospital Merkur, Zagreb 10000, Croatia
| | - Tomislav Bubalo
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
| | - Danko Mikulić
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
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Bezjak M, Kocman B, Jadrijević S, Gašparović H, Mrzljak A, Kanižaj TF, Vujanić D, Bubalo T, Mikulić D. Constrictive pericarditis as a cause of refractory ascites after liver transplantation: A case report. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i20.3267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Han SHB, Yau C, Chin EE. Ascites Due to Constrictive Pericardial Disease Not Appreciated on Echocardiogram: A Report of Three Cases. Dig Dis Sci 2018; 63:797-802. [PMID: 29349692 DOI: 10.1007/s10620-018-4920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/07/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Steven-Huy B Han
- Pfleger Liver Institute, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Celia Yau
- Pfleger Liver Institute, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA
| | - Eva E Chin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Abstract
We report a 43-year-old man who presented for evaluation of ascites, varices, and hepatosplenomegaly. Initial labs were notable for normal platelets, mild liver synthetic dysfunction, and disproportionately elevated alkaline phosphatase. He was presumed to have underlying cirrhosis, and diuresis was attempted without success. A transjugular liver biopsy showed marked sinusoidal dilation without cirrhosis. Diagnostic paracentesis revealed fluid studies suggestive of cardiac ascites. Further cardiac evaluation confirmed constrictive pericarditis. The case highlights the importance of considering a broad differential in the evaluation of ascites.
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An unusual case of cirrhosis. Case Rep Gastrointest Med 2014; 2014:670176. [PMID: 24782928 PMCID: PMC3978404 DOI: 10.1155/2014/670176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/17/2013] [Indexed: 12/02/2022] Open
Abstract
49-year-old white female with remote h/o sarcoidosis was referred to GI when her liver was noted to be nodular. Physical examination revealed normal vital signs and no icterus, spider nevi, clubbing, ascites, hepatosplenomegaly, or ankle edema. LFTs, hepatitis serologies, ANA, AMA, ASMA, Ferritin, Ceruloplasmin, and α1-AT, level were unremarkable. Liver biopsy showed cirrhosis. She developed worsening of baseline SOB and was hospitalized. She was eventually diagnosed with constrictive pericarditis. A diagnosis of cardiac cirrhosis was made.
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George BA, Deprisco G, Trotter JF, Henry AC, Stoler RC. Ascites with elevated protein content as the presenting sign of constrictive pericardial disease. Proc (Bayl Univ Med Cent) 2013; 26:168-70. [PMID: 23543979 DOI: 10.1080/08998280.2013.11928950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Two men, one 63 and one 52 years old, presented with ascites. Analysis of the ascitic fluid in both patients revealed a high protein content and an elevated serum-ascites gradient. Various studies showed the cause of the ascites to be constrictive pericardial disease. Total excision of their parietal pericardia relieved their symptoms, decreased their cardiac filling pressures, and increased their cardiac indices. These cases highlight the importance of suspecting pericardial constriction as an etiology for high-protein-count ascites.
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Howard JP, Jones D, Mills P, Marley R, Wragg A. Recurrent ascites due to constrictive pericarditis. Frontline Gastroenterol 2012; 3:233-237. [PMID: 28839673 PMCID: PMC5369818 DOI: 10.1136/flgastro-2012-100173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/07/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- James Philip Howard
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Daniel Jones
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Peter Mills
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
| | - Richard Marley
- Department of Gastroenterology, Barts and the London NHS Trust, London, UK
| | - Andrew Wragg
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
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Abstract
Congestive hepatopathy is a known complication of cardiac disease and is typically identified in the context of an established cardiac diagnosis and profound cardiopulmonary symptoms. We report the case of a 28-year-old man with liver disease secondary to asymptomatic constrictive pericarditis. This case highlights the need for gastroenterologists to consider occult cardiac disease as a cause of unexplained liver dysfunction.
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Johnson KT, Julsrud PR, Johnson CD. Constrictive pericarditis at abdominal CT: a commonly overlooked diagnosis. ACTA ACUST UNITED AC 2008; 33:349-52. [PMID: 17510764 DOI: 10.1007/s00261-007-9246-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate findings at abdominal computed tomography (CT) in patients with proven constrictive pericarditis. METHODS The medical records of 25 patients with surgically proven constrictive pericarditis and abdominal CT examinations within 30 days of operation were reviewed. Clinical symptoms, laboratory findings and prospective CT findings were collated. The CT examinations were also retrospectively reviewed in an unblinded fashion. RESULTS Direct CT findings of constrictive pericarditis with an abnormal pericardium were present in 23/25 patients. Only 9 of 25 (36%) patients were detected prospectively. Findings on retrospective review included pericardial calcification (10/25, 40%) or thickening (13/25, 52%), dilated IVC (20/25), dilated hepatic veins (14/25), ascites (14/25), mesenteric soft tissue stranding (12/25), mottled enhancement of the hepatic parenchyma (8/25), and cirrhosis (6/25). Anemia was present in (17/25), and an elevated AST levels occurred in 48% (12/25) of patients. The most common abdominal symptoms were pain (4/12), diarrhea (4/12), distention (3/12), and bloating (1/12). CONCLUSIONS Constrictive pericarditis can present with vague abdominal symptoms. Anemia and elevated liver function tests are common laboratory abnormalities. Indirect CT findings of dilated IVC and/or hepatic veins, ascites, or cirrhosis should prompt inspection of the pericardium. In the majority of cases an abnormal pericardium could be identified (thickened, calcified or both).
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Affiliation(s)
- Kristina T Johnson
- Department of Radiology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
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Srinivasan N, Gupta R, Garrison M, Blevins S. Heart in a hard cage: startling calcific constrictive pericarditis. ACTA ACUST UNITED AC 2008; 14:161-3. [PMID: 18550929 DOI: 10.1111/j.1751-7133.2008.08025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nandakumar Srinivasan
- Department of Internal Medicine, Health Science Center, University of Oklahoma, Oklahoma City, OK, USA
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The Liver in Systemic Illness. ZAKIM AND BOYER'S HEPATOLOGY 2006. [PMCID: PMC7155679 DOI: 10.1016/b978-1-4160-3258-8.50061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ridruejo E, Mandó OG. Chylous ascites as the main manifestation of left ventricular dysfunction: a case report. BMC Gastroenterol 2005; 5:25. [PMID: 16078991 PMCID: PMC1192795 DOI: 10.1186/1471-230x-5-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/03/2005] [Indexed: 01/22/2023] Open
Abstract
Background Ascites is one of the most common complications of liver diseases, even though in 15% of the cases it is related to extrahepatic diseases; 3% are of cardiac nature and they appear associated with signs and symptoms of heart failure. Case presentation A 70 year old man was admitted with more than one year history of abdominal distension and a weight gain of 10 kilograms. He is asymptomatic and walks 2000–3000 meters a day without angor or dyspnea. The physical examination shows moderate abdominal distension, with no hepatosplenomegaly or edema, and there is mild jugular vein distension. The studies performed (complete laboratory work up, paracentesis, liver biopsy, echocardiogram, intrahepatic pressure measurements, etc.) showed a chylous ascites related to portal hypertension, and left ventricular dysfunction was the only probable cause found. Conclusion Asymptomatic heart dysfunction can mimic liver disease and should be kept in mind as a cause of chylous ascites.
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Affiliation(s)
- Ezequiel Ridruejo
- Hepatology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Las Heras 2939, (1425), Buenos Aires, Argentina
| | - Oscar G Mandó
- Hepatology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Las Heras 2939, (1425), Buenos Aires, Argentina
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Caumes JL, Cholet F, Richecoeur M, Nicolas X, Bire F, Bergez C, Peghini M, Klotz F. Ascite par péricardite constrictive. Presse Med 2005; 34:29-31. [PMID: 15685095 DOI: 10.1016/s0755-4982(05)83880-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We report a case in which ascites revealed chronic constrictive pericarditis (CCP) of tuberculous origin. OBSERVATION A 65 year-old man had developed ascites the past over few weeks and oedema of the lower limbs. Treatment was surgical and consisted in pericardiectomy. DISCUSSION Chronic constrictive pericarditis has become rare in industrialised countries with the reduction in the incidence of tuberculosis. Currently, its principle aetiologies identified are previous cardiac surgery and radiotherapy. Treatment is usually surgical and gives excellent results. This clinical case clearly illustrates the interest of systematic biological analysis of ascites, since it may reveal a curable disease.
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MESH Headings
- Aged
- Ascites/microbiology
- Ascitic Fluid/chemistry
- Cardiac Catheterization
- Chronic Disease
- Echocardiography, Transesophageal
- Edema/microbiology
- France/epidemiology
- Humans
- Incidence
- Magnetic Resonance Imaging
- Male
- Pericardiectomy
- Pericarditis, Constrictive/complications
- Pericarditis, Constrictive/diagnosis
- Pericarditis, Constrictive/epidemiology
- Pericarditis, Constrictive/surgery
- Pericarditis, Tuberculous/complications
- Pericarditis, Tuberculous/diagnosis
- Pericarditis, Tuberculous/epidemiology
- Pericarditis, Tuberculous/surgery
- Radiography, Thoracic
- Rare Diseases
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Jean-Luc Caumes
- Service de pathologie digestive, HIA Clermont Tonnerre, Brest Naval
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