This was a very interesting problem . I learnt a few things over a period of time . May be many others would have got the diagnosis easily.
This was a 27 year old man working as an I.T.consultant in a city. He started getting headaches , which were disabling . The headache was mostly one sided . He was evaluated for the headache ; His CT scan of the brain was normal. He had features of iron defeciency anemia with thrombocytosis . His neurologist after a bit of trial and error made a diagnosis of ‘ indomethacin sensitive chronic paroxysmal hemicranial headache ‘ . He responded very well to indomethacin . But his anemia was not improving with medical treatment.
An ultrasound abdomen was done as part of evaluation of anemia.
Now for the unexpected findings . To finish off the scan , I was sweeping the aorta, IVC and the pre and post aortic regions.
The following image was obtained with the transducer in the mid epigastric region and an inch to the left of the mid line.
This mass visualised there . This was antero-lateral to the aorta and showed mixed echotexture , with some vascularity.
This was not mobile and all i could offer was a description of what was seen with the impression of a mass of unknown origin – ?? enlarged node and advised further work up.
He underwent a contrast CT and was found to have a mass arising from the intestinal wall. He underwent surgery subsequently and the mass was removed . It was a benign leiomyoma arising from the jejunal wall and showed some erosions on the inner aspect ( cause for the anemia ) . Now came the pleasant surprise for everybody.His anemia improved and his headaches disappeared totally. The explanation offered was reactive thrombocytosis due to the anemia probably caused the hemicranial pain and when that was taken care of he was better.
Many others looking at the ultrasound image could have probably guessed the pathology. But I was happy that at least I picked up the mass , which led to the other things.