A 32-year-old man who was discharged 5 weeks ago after hospitalization for acute pancreatitis returns to the ED complaining of epigastric abdominal pain and early satiety. An abdominal ultrasound is obtained with a substantial fluid collection noted, and a CT scan is recommended for further classification. Which of the following CT findings would be more consistent with a walled-off necrosis versus a pseudocyst?
A. Well-circumscribed fluid collection that is round
B. Heterogenous fluid collection with liquid and nonliquid density, with varying degrees of loculation
C. Absence of internal septae within the cyst cavity
D. A well-defined wall that completely encapsulates the fluid collection
E. A fluid collection that is extrapancreatic
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A 52-year-old woman has had acute pancreatitis due to gallstones. Six weeks later, she has persistent nausea and is unable to eat. A CT scan shows that the inflammation have resolved, but there is a 10 cm pancreatic pseudocyst posterior to the stomach which is displacing it anteriorly. MRCP shows communication between the pancreatic duct and the pseudocyst. The most appropriate management is
A. pseudocyst-gastrostomy with cholecystectomy
B. percutaneous aspiration
C. continue total parenteral nutrition for 3 more weeks
D. administer somatostatin analogue
E. perform pancreatic duct stenting
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