subcapsular hematoma of dimensions 24 cm x 9.2 cm x 3.9 cm at the level of the right hepatic lobe. The pain continued to worsen with a drop in hemoglobin from 12.8 gm/dl at admission to 7.1 gm/dl on day 4. IR was consulted for rupture concern and recommended CT angiography of abdomen and pelvis with and without arterial/venous phase that showed similar appearing subcapsular hematoma without an active bleed. Underwent image-guided hepatic angiography that showed large perihepatic hematoma along the right lateral abdominal wall without active contrast extravasation. Right hepatic artery embolization was done with a reduction in peripheral hepatic arterial blood flow by 25%. Later hemoglobin stabilized, liver enzymes improved, and the patient was discharged home 6 days later in a clinically stable state (Figure). Discussion: Early diagnosis of subcapsular hematoma is challenging due to nonspecific signs and symptoms but crucial for improved outcomes. Physicians should evaluate for a subcapsular hematoma in patients with HELLP and RUQ pain or hypotension. Therapeutic options for ruptured hematomas include laparotomy and hepatic artery embolization.[3162] Figure 1. Coronal section of MRI with IV contrast (Liver mass protocol) of abdomen and pelvis demonstrates subcapsular hepatic hematoma involving the hepatic dome and right hepatic lobe approximately measuring 24 cm in craniocaudal dimension.

Introduction: Any mass lesion in the pancreas typically raises concern of undiagnosed pancreatic malignancy. Presence of synchronous multiple pancreatic masses is a rare finding. In this case series, patients presented with two or more synchronous solid masses as a result of pancreatic cancer (PC), autoimmune pancreatitis (AIP), and sarcoidosis. Case Description/Methods: Case1:65-year-old female presented with abdominal pain and 20lbs unintentional weight loss over 4 months. CT scan revealed two suspicious solid masses in the body/tail of the pancreas (Figure A). IgG4 level was normal, but CA19-9 was elevated at 75u/mL. EUS with individual fine needle biopsies (FNB) of both masses confirmed infiltrative PC. Due to the significant cardiac history, the patient was deemed not a surgical candidate and was referred to oncology for chemoradiation/palliative therapy. Case2:76-year-old male presented to the hospital with postprandial abdominal discomfort and unintentional weight loss. CT Abdomen demonstrated localized inflammation in the pancreatic tail (Figure B). EUS showed mass-like lesions in the pancreatic head and tail. Immunohistochemistry was positive for IgG4-positive plasma cells. He was diagnosed with AIP and was started on steroids. Case3:54-year-old male with complicated sarcoidosis (pulmonary/extrapulmonary involvement), presented with an abnormal PET scan showing focal increased uptake in the head/tail of the pancreas. His CT scan did not show any mass or duct dilation. EUS demonstrated ill-defined, infiltrative masses involving the pancreatic head and the tail. FNB showed scattered non-necrotizing granulomas (Figure C). After excluding other causes of granulomatous diseases, he was diagnosed with pancreatic sarcoidosis. Discussion: Only a few examples of synchronous pancreatic masses have been recorded in the medical literature. Our case series includes three distinct pancreatic diseases that result in multiple mass lesions with similar appearance on imaging (Table ). The clinical course for all of the patients differed greatly depending on the pathology. The plurality of solid masses and comparable imaging features of each with PC, which is the 4th highest cause of cancer-related deaths in the United States is the highlight of this series. When encountering such individuals, a broad differential should be examined, as the clinical history of the illness varies. The whole pancreas should be investigated with multimodal imaging and EUS-guided acquisition histopathology to reach a clear diagnosis.

Colonic surface area for humans is ;3,000 greater than rat. Considering species-specific MC1R receptor sensitivity differences and other variables, such as GI transit time, pH, and proteolytic enzyme activity, a dose of 20 mg/day was estimated to be the best choice for observation of efficacy in the phase 2 trial. Conclusion: Collectively, these findings support further development of PL8177 as a treatment option for GI inflammatory diseases in humans. This will be further examined in the phase 2 trial in humans with UC.

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