Ultrasonography of non-dependent lung parenchyma can reliably detect evolving respiratory dysfunction in AP. This simple bedside technique shows promise as an adjunct to severity stratification.

Clinical features together with elevation of pancreatic enzymes are the key diagnostic indicators of acute pancreatitis. We report a case of a woman in her 50s who presented with abdominal distension and serum amylase raised to more than 30 times the upper limit of normal. She was initially treated for acute pancreatitis, however, she was not symptomatic of this and the pancreas appeared to be normal on CT scan. Further investigations revealed the patient had a high-grade serous ovarian carcinoma with nodal metastatic spread. An amylase-secreting ovarian tumour was suspected, which was supported by elevated salivary-amylase isoenzymes, consistent with previous reports in the literature. The patient was treated with chemotherapy and surgery, during which her serum amylase and CA-125 initially fell significantly, but eventually both increased, reflecting disease progression. This case serves as an important reminder to consider non-pancreatic causes of raised serum amylase, to avoid misdiagnosis.

Background: The value of lung ultrasonography in the diagnosis of respiratory dysfunction and severity stratification in patients with acute pancreatitis (AP) was investigated.

society provides guidance on the importance of following up incidental nodules identified on computed tomography (CT) scanning, highlighting the prevalence of lung cancer. [7] Nevertheless, the chest radiograph (CXR) remains the workhorse of chest imaging and the first-line investigation for the majority of symptomatic patients. Previous studies have shown CXR to have a poor sensitivity of 23% when compared to CT. [8] Importantly, the performance of the CXR falls as the size of the lesions decrease, limiting the sensitivity for detecting the very lesions with greatest potential curability. [3,8] When compiling the disease stage of patients at diagnosis, NICE found that almost 50% had Stage IV disease and only 14% had Stage I disease with more advanced disease stage at initial diagnosis negatively impacting treatment options and prognosis. [9]

BackgroundHigh resolution computed tomography (HRCT) scanning is able to detect abnormalities consistent with interstitial lung disease (ILD). However, if only a small proportion of lung is affected, radiologists variously report this as ‘minimal’, ‘minor’ or ‘early’ ILD. There is no definition of what constitutes ‘minimal’ ILD and the natural history of these patients is not known.AimsTo define ‘minimal’ ILD, test observer agreement with this definition and describe the characteristics and survival of these patients.HypothesisMinimal ILD can be defined by subjective quantification and has a benign course.MethodsBetween 01.01.2002 and 31.12.2014 the Edinburgh Lung Fibrosis Database was prospectively populated with data for 1450 consecutively presenting patients with ILD. Of these, 56 were identified as presenting with ‘minimal’ disease according to HRCT. Three radiologists participated in a modified Delphi exercise and agreed on a definition of ‘minimal’ ILD. A sample (n = 38) of HRCT scans was provided to test inter- and intra-observer agreement according to this definition using Fleiss’ Kappa statistics. Survival was assessed using Kaplan-Meier curves.ResultsThe Delphi exercise resulted in ‘minimal’ disease being defined as ILD involving <5% of the total lung volume and/or <10% of the lung peripheries. Using this definition, inter-observer and intra-observer agreement was moderate (kappa 0.42 and 0.58 respectively). Of the 56 subjects originally deemed as ‘minimal’ ILD, 48 were unanimously described as minimal disease by post-definition criteria. One subject was biopsied (consensus after biopsy, unclassifiable). Forty-seven subjects were not biopsied and none met ATS/ERS consensus criteria for diagnosing IPF. Most subjects had ‘unclassifiable’ disease, but the working diagnoses were; IPF or other fibrotic idiopathic interstitial pneumonia (IIP) (n = 34), IIP without fibrosis (n = 7) and connective-tissue disease associated ILD (n = 7). The median age was 69yrs, 56% were male and 23% had never smoked. The mean (SD) %pred lung function was; FEV1 91.8% (19), VC 101% (18) TCO 62% (19). The median survival was 11.6 years, and all deaths (n = 12) were attributable to respiratory disease.SummaryDefining ‘minimal’ ILD is feasible and there was moderate radiological agreement. Minimal ILD is relatively benign, but the associated mortality was of respiratory cause.Abstract S18 Figure 1Survival of minimal ILD