PMC5343001_01
Chest X-ray posteroanterior (A) and lateral (B) views showing bilateral pleural effusions, with bibasilar opacification, most likely from compressive atelectasis.
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Chest X-ray (Fig. 1) revealed moderate bilateral pleural effusions.
Computed tomography (CT) of the abdomen and pelvis with intravenous contrast representative axial (A-D) and coronal (E) sections showing bilateral pleural effusion (white star) right greater than left with underlying compressive atelectasis, thickening of the distal part of the stomach (blue arrows) and an enlarged, edematous uniformly enhancing pancreas (red dot). There was differential perfusion and excretion of the kidneys with the left kidney (yellow arrow) hypoenhancing relative to the right, mild left hydronephrosis without any identified obstructing lesion. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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CT abdomen pelvis showed (Fig. 2) diffuse enlargement of the pancreas and pancreatic edema, bilateral pleural effusion, distal thickening of the stomach and decreased perfusion to her left kidney with mild hydronephrosis.
Upper GI Endoscopy with representative endoscopic images of the gastric body (A) with mucosal changes consistent with infiltrative disease. Images of the greater curvature of the stomach (B) showed marked enlargement of the folds in mid-body of stomach extending to proximal antrum. The folds along the lesser curvature were absent and replaced with a hard, plaque-like infiltration. The mid body of the stomach was severely narrowed by this process, causing partial obstruction.
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EGD was performed (Fig. 3) showing infiltrative process in the stomach.