Primary hydatid cyst of the pancreas

Abstract Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context...

Full description

Saved in:
Bibliographic Details
Published in:Journal of pediatric surgery case reports Vol. 26; no. C; pp. 48 - 50
Main Authors: El Bakkaly, A, Merouane, N, Dalero, O, Oubeja, H, Erraji, M, Ettayebi, F, Zerhouni, H
Format: Journal Article
Language:English
Published: Elsevier Inc 01-11-2017
Elsevier
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract Abstract Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context of conservation of the general condition and apyrexia. Clinical examination and preoperative imaging have suggested the diagnosis of a choledochal cyst or duodenal duplication rather than a hydatid cyst of the pancreas due to the presence of a cystic hepatic image projecting into the liver hilum. During the procedure, a hydatid cyst was found occupying the head of the pancreas. Primary hydatidosis of the pancreas in children is extremely rare. Possible sources of infection include: Blood diffusion, local spread via biliopancreatic ducts and peripancreatic lymphatic invasion. In the endemic areas, hydatid disease should be mentioned in the list of differential diagnoses of cystic lesions located around the biliopancreatic junction in children.
AbstractList Abstract Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context of conservation of the general condition and apyrexia. Clinical examination and preoperative imaging have suggested the diagnosis of a choledochal cyst or duodenal duplication rather than a hydatid cyst of the pancreas due to the presence of a cystic hepatic image projecting into the liver hilum. During the procedure, a hydatid cyst was found occupying the head of the pancreas. Primary hydatidosis of the pancreas in children is extremely rare. Possible sources of infection include: Blood diffusion, local spread via biliopancreatic ducts and peripancreatic lymphatic invasion. In the endemic areas, hydatid disease should be mentioned in the list of differential diagnoses of cystic lesions located around the biliopancreatic junction in children.
Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context of conservation of the general condition and apyrexia. Clinical examination and preoperative imaging have suggested the diagnosis of a choledochal cyst or duodenal duplication rather than a hydatid cyst of the pancreas due to the presence of a cystic hepatic image projecting into the liver hilum. During the procedure, a hydatid cyst was found occupying the head of the pancreas. Primary hydatidosis of the pancreas in children is extremely rare. Possible sources of infection include: Blood diffusion, local spread via biliopancreatic ducts and peripancreatic lymphatic invasion. In the endemic areas, hydatid disease should be mentioned in the list of differential diagnoses of cystic lesions located around the biliopancreatic junction in children.
Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who consulted for isolated abdominal pain occurring for 2 weeks without vomiting, transit disorders or jaundice and evolving in a context of conservation of the general condition and apyrexia. Clinical examination and preoperative imaging have suggested the diagnosis of a choledochal cyst or duodenal duplication rather than a hydatid cyst of the pancreas due to the presence of a cystic hepatic image projecting into the liver hilum. During the procedure, a hydatid cyst was found occupying the head of the pancreas. Primary hydatidosis of the pancreas in children is extremely rare. Possible sources of infection include: Blood diffusion, local spread via biliopancreatic ducts and peripancreatic lymphatic invasion. In the endemic areas, hydatid disease should be mentioned in the list of differential diagnoses of cystic lesions located around the biliopancreatic junction in children.
Author Oubeja, H
Ettayebi, F
Erraji, M
El Bakkaly, A
Merouane, N
Dalero, O
Zerhouni, H
Author_xml – sequence: 1
  fullname: El Bakkaly, A
– sequence: 2
  fullname: Merouane, N
– sequence: 3
  fullname: Dalero, O
– sequence: 4
  fullname: Oubeja, H
– sequence: 5
  fullname: Erraji, M
– sequence: 6
  fullname: Ettayebi, F
– sequence: 7
  fullname: Zerhouni, H
BookMark eNp9kUFr3DAQhUVIIOlm_0BOPuS6zsiyZBlCoIS2CQRaSHIWs6NxV-7GXiS3sP8-craUkkNOMwy8N_O--SSOh3FgIS4klBKkuepL3iUqK5BNCbYEUEfirKqkWunGmOP_-lOxTKkHAFlp3Sp1Ji5_xPCCcV9s9h6n4Avap6kYu2LacLHDgSJjOhcnHW4TL__WhXj--uXp9m718P3b_e3nhxXV0kwrBTVU2jd1LS3btkMCo3xDkNev67Uli1obBN_qNVrvUZM0RCBV1-gaUC3E_cHXj9i73eEyN2Jwb4Mx_nQYp0BbdhoVaq-8lXldq9t105FVKJkNGMzRFqI6eFEcU4rc_fOT4GZsrnczNjdjc2BdxpZF1wcR55R_AkeXKPBA7ENkmvIZ4WP5zTs5bcMQCLe_eM-pH3_HIfNz0qXKgXuc_zK_RTYqQ9BavQL-Wooz
Cites_doi 10.1016/j.gcb.2007.12.014
10.1016/j.jpedsurg.2012.07.054
10.1016/S0022-3468(99)90509-2
10.1053/jpsu.2003.50058
10.1007/s003830050024
10.1016/S0399-8320(07)89405-X
10.5152/tpd.2011.13
10.1016/j.arcped.2010.03.005
10.1007/s003830050677
10.1159/000018829
10.1159/000260908
10.1055/s-2008-1066184
ContentType Journal Article
Copyright The Authors
2017 The Authors
Copyright_xml – notice: The Authors
– notice: 2017 The Authors
DBID 6I.
AAFTH
AAYXX
CITATION
DOA
DOI 10.1016/j.epsc.2017.08.003
DatabaseName ScienceDirect Open Access Titles
Elsevier:ScienceDirect:Open Access
CrossRef
Directory of Open Access Journals
DatabaseTitle CrossRef
DatabaseTitleList


Database_xml – sequence: 1
  dbid: DOA
  name: Directory of Open Access Journals
  url: http://www.doaj.org/
  sourceTypes: Open Website
DeliveryMethod fulltext_linktorsrc
EISSN 2213-5766
EndPage 50
ExternalDocumentID oai_doaj_org_article_5a3a5d3d81744959b7fc83a1ee606a93
10_1016_j_epsc_2017_08_003
S2213576617301355
1_s2_0_S2213576617301355
GroupedDBID .1-
.FO
0R~
0SF
1P~
4.4
457
53G
5VS
6I.
AACTN
AAEDT
AAEDW
AAFTH
AAIKJ
AALRI
AAXUO
ABFRF
ABMAC
ACGFS
ADBBV
ADEZE
ADVLN
AEFWE
AEVXI
AEXQZ
AFCTW
AFJKZ
AFRHN
AFTJW
AGHFR
AITUG
AJUYK
AKRWK
ALMA_UNASSIGNED_HOLDINGS
AMRAJ
BCNDV
EBS
EJD
FDB
GROUPED_DOAJ
GX1
HZ~
IPNFZ
IXB
KQ8
M41
M48
M~E
NCXOZ
O-L
O9-
OK-
OK1
OW-
RIG
ROL
SSZ
UNMZH
Z5R
AAYXX
CITATION
ID FETCH-LOGICAL-c416t-304025d74418e89fac063d7c0213b4b8c8a556a0d95ba8dda5c16cc013f7540a3
IEDL.DBID DOA
ISSN 2213-5766
IngestDate Tue Oct 22 15:15:59 EDT 2024
Thu Sep 26 18:46:17 EDT 2024
Fri Feb 23 02:21:01 EST 2024
Tue Oct 15 22:58:45 EDT 2024
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue C
Keywords Treatment
Pancreas
Hydatid cyst
Child
Language English
License This is an open access article under the CC BY-NC-ND license.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c416t-304025d74418e89fac063d7c0213b4b8c8a556a0d95ba8dda5c16cc013f7540a3
ORCID 0000-0001-7371-2816
OpenAccessLink https://doaj.org/article/5a3a5d3d81744959b7fc83a1ee606a93
PageCount 3
ParticipantIDs doaj_primary_oai_doaj_org_article_5a3a5d3d81744959b7fc83a1ee606a93
crossref_primary_10_1016_j_epsc_2017_08_003
elsevier_sciencedirect_doi_10_1016_j_epsc_2017_08_003
elsevier_clinicalkeyesjournals_1_s2_0_S2213576617301355
PublicationCentury 2000
PublicationDate 2017-11-01
PublicationDateYYYYMMDD 2017-11-01
PublicationDate_xml – month: 11
  year: 2017
  text: 2017-11-01
  day: 01
PublicationDecade 2010
PublicationTitle Journal of pediatric surgery case reports
PublicationYear 2017
Publisher Elsevier Inc
Elsevier
Publisher_xml – name: Elsevier Inc
– name: Elsevier
References Abid, Guirat, Ben Salah, Khlif, Frikha, Mzali (bib1) 2010; 17
Cankorkmaz, Gümüş, Celiksöz, Köylüoğlu (bib3) 2011; 35
Khiari, Mzali, Ouali, Kharrat, Kechaou, Beyrouti (bib6) 1994; 30
Hamzaoui, Gasmi, Sahli, Essid, Houissa (bib7) 2007; 31
Mandelia, Wahal, Solanki, Srinivas, Bhatnagar (bib5) 2012; 47
Erdener, Sahin, Ozcan (bib10) 1999; 34
Arikan, Sayan, Erikçi (bib11) 1999; 15
Otgün, Karnak, Haliloglu, Senocak (bib13) 2003; 38
Gangopadhyay, Sahoo, Sharma, Gupta, Sinha, Rai (bib14) 2000; 16
Wani, Shah, Zargar, Baba, Dar (bib12) 2000; 17
Ismail, Haluk, Necati (bib15) 1991; 76
Errougani, Chkoff, Koutani, Ouafdel, Benchekroun (bib4) 1991; 30
Dagtekin, Koseoglu, Kara, Karabag, Avci, Torun (bib8) 2009; 45
Bedioui, Chebbi, Ayadi, Daghfous, Bakhtri, Jouini (bib2) 2008; 32
Brown, Millar, Steiner, Krige, Burkimsher, Cywes (bib9) 1995; 5
Cankorkmaz (10.1016/j.epsc.2017.08.003_bib3) 2011; 35
Errougani (10.1016/j.epsc.2017.08.003_bib4) 1991; 30
Gangopadhyay (10.1016/j.epsc.2017.08.003_bib14) 2000; 16
Mandelia (10.1016/j.epsc.2017.08.003_bib5) 2012; 47
Bedioui (10.1016/j.epsc.2017.08.003_bib2) 2008; 32
Otgün (10.1016/j.epsc.2017.08.003_bib13) 2003; 38
Arikan (10.1016/j.epsc.2017.08.003_bib11) 1999; 15
Wani (10.1016/j.epsc.2017.08.003_bib12) 2000; 17
Dagtekin (10.1016/j.epsc.2017.08.003_bib8) 2009; 45
Khiari (10.1016/j.epsc.2017.08.003_bib6) 1994; 30
Brown (10.1016/j.epsc.2017.08.003_bib9) 1995; 5
Hamzaoui (10.1016/j.epsc.2017.08.003_bib7) 2007; 31
Abid (10.1016/j.epsc.2017.08.003_bib1) 2010; 17
Erdener (10.1016/j.epsc.2017.08.003_bib10) 1999; 34
Ismail (10.1016/j.epsc.2017.08.003_bib15) 1991; 76
References_xml – volume: 17
  start-page: 1056
  year: 2010
  end-page: 1058
  ident: bib1
  article-title: Kyste hydatique du pancréas : une localisation exceptionnelle
  publication-title: Arch Pédiatr
  contributor:
    fullname: Mzali
– volume: 76
  start-page: 185
  year: 1991
  end-page: 188
  ident: bib15
  article-title: Surgical treatment of hydatid cysts of the pancreas
  publication-title: Int Surg
  contributor:
    fullname: Necati
– volume: 30
  start-page: 87
  year: 1994
  end-page: 91
  ident: bib6
  article-title: Hydatid cyst of the pancreas: a propos of 7 cases
  publication-title: Ann Gastroenterol Hepatol Paris
  contributor:
    fullname: Beyrouti
– volume: 32
  start-page: 102
  year: 2008
  end-page: 106
  ident: bib2
  article-title: Kyste hydatique primitif du pancréas : diagnostic et modalités chirurgicales. à propos de trois cas
  publication-title: Gastroentérol Clin Biol
  contributor:
    fullname: Jouini
– volume: 5
  start-page: 121
  year: 1995
  end-page: 123
  ident: bib9
  article-title: Hydatid cyst of the pancreas—a case report in a child
  publication-title: Eur J Pediatr Surg
  contributor:
    fullname: Cywes
– volume: 38
  start-page: 256
  year: 2003
  end-page: 258
  ident: bib13
  article-title: Obstructive jaundice caused by primary choledochal hydatid cyst mimicking radiologically choledochal cyst
  publication-title: J Pediatr Surg
  contributor:
    fullname: Senocak
– volume: 31
  start-page: 428
  year: 2007
  end-page: 430
  ident: bib7
  article-title: Une angiocholite aiguë révélant un kyste hydatique du pancréas chez l'enfant
  publication-title: Gastroenterol Clin Biol
  contributor:
    fullname: Houissa
– volume: 30
  start-page: 27
  year: 1991
  end-page: 30
  ident: bib4
  article-title: Le kyste hydatique du pancréas: à propos d’une observation
  publication-title: Méd Maghreb
  contributor:
    fullname: Benchekroun
– volume: 35
  start-page: 50
  year: 2011
  end-page: 52
  ident: bib3
  article-title: Primary hydatid disease of the pancreas mimicking pancreatic pseudo-cyst in a child: case report and review of the literature
  publication-title: Turk Parazitol Derg
  contributor:
    fullname: Köylüoğlu
– volume: 34
  start-page: 491
  year: 1999
  end-page: 492
  ident: bib10
  article-title: Primary pancreatic hydatid disease in a child: case report and review of the literature
  publication-title: J Pediatr Surg
  contributor:
    fullname: Ozcan
– volume: 15
  start-page: 579
  year: 1999
  end-page: 581
  ident: bib11
  article-title: Hydatid cyst of the pancreas : a case report with 5 years' follow-up
  publication-title: Pediatr Surg Int
  contributor:
    fullname: Erikçi
– volume: 16
  start-page: 89
  year: 2000
  end-page: 90
  ident: bib14
  article-title: Hydatid disease in children may have an atypical presentation
  publication-title: Pediatr Surg Int
  contributor:
    fullname: Rai
– volume: 45
  start-page: 379
  year: 2009
  end-page: 383
  ident: bib8
  article-title: Unusual location of hydatid cysts in pediatric patients
  publication-title: Pediatr Neurosurg
  contributor:
    fullname: Torun
– volume: 47
  start-page: 41
  year: 2012
  end-page: 44
  ident: bib5
  article-title: Pancreatic hydatid cyst masquerading as a choledochal cyst
  publication-title: J Pediatr Surg
  contributor:
    fullname: Bhatnagar
– volume: 17
  start-page: 188
  year: 2000
  end-page: 190
  ident: bib12
  article-title: Hydatid cysts of the pancreas
  publication-title: Dig Surg
  contributor:
    fullname: Dar
– volume: 76
  start-page: 185
  issue: 3
  year: 1991
  ident: 10.1016/j.epsc.2017.08.003_bib15
  article-title: Surgical treatment of hydatid cysts of the pancreas
  publication-title: Int Surg
  contributor:
    fullname: Ismail
– volume: 32
  start-page: 102
  issue: 1
  year: 2008
  ident: 10.1016/j.epsc.2017.08.003_bib2
  article-title: Kyste hydatique primitif du pancréas : diagnostic et modalités chirurgicales. à propos de trois cas
  publication-title: Gastroentérol Clin Biol
  doi: 10.1016/j.gcb.2007.12.014
  contributor:
    fullname: Bedioui
– volume: 47
  start-page: 41
  issue: 11
  year: 2012
  ident: 10.1016/j.epsc.2017.08.003_bib5
  article-title: Pancreatic hydatid cyst masquerading as a choledochal cyst
  publication-title: J Pediatr Surg
  doi: 10.1016/j.jpedsurg.2012.07.054
  contributor:
    fullname: Mandelia
– volume: 34
  start-page: 491
  issue: 3
  year: 1999
  ident: 10.1016/j.epsc.2017.08.003_bib10
  article-title: Primary pancreatic hydatid disease in a child: case report and review of the literature
  publication-title: J Pediatr Surg
  doi: 10.1016/S0022-3468(99)90509-2
  contributor:
    fullname: Erdener
– volume: 38
  start-page: 256
  issue: 2
  year: 2003
  ident: 10.1016/j.epsc.2017.08.003_bib13
  article-title: Obstructive jaundice caused by primary choledochal hydatid cyst mimicking radiologically choledochal cyst
  publication-title: J Pediatr Surg
  doi: 10.1053/jpsu.2003.50058
  contributor:
    fullname: Otgün
– volume: 16
  start-page: 89
  issue: 1–2
  year: 2000
  ident: 10.1016/j.epsc.2017.08.003_bib14
  article-title: Hydatid disease in children may have an atypical presentation
  publication-title: Pediatr Surg Int
  doi: 10.1007/s003830050024
  contributor:
    fullname: Gangopadhyay
– volume: 31
  start-page: 428
  issue: 4
  year: 2007
  ident: 10.1016/j.epsc.2017.08.003_bib7
  article-title: Une angiocholite aiguë révélant un kyste hydatique du pancréas chez l'enfant
  publication-title: Gastroenterol Clin Biol
  doi: 10.1016/S0399-8320(07)89405-X
  contributor:
    fullname: Hamzaoui
– volume: 30
  start-page: 87
  issue: 3
  year: 1994
  ident: 10.1016/j.epsc.2017.08.003_bib6
  article-title: Hydatid cyst of the pancreas: a propos of 7 cases
  publication-title: Ann Gastroenterol Hepatol Paris
  contributor:
    fullname: Khiari
– volume: 35
  start-page: 50
  issue: 1
  year: 2011
  ident: 10.1016/j.epsc.2017.08.003_bib3
  article-title: Primary hydatid disease of the pancreas mimicking pancreatic pseudo-cyst in a child: case report and review of the literature
  publication-title: Turk Parazitol Derg
  doi: 10.5152/tpd.2011.13
  contributor:
    fullname: Cankorkmaz
– volume: 17
  start-page: 1056
  issue: 7
  year: 2010
  ident: 10.1016/j.epsc.2017.08.003_bib1
  article-title: Kyste hydatique du pancréas : une localisation exceptionnelle
  publication-title: Arch Pédiatr
  doi: 10.1016/j.arcped.2010.03.005
  contributor:
    fullname: Abid
– volume: 15
  start-page: 579
  issue: 8
  year: 1999
  ident: 10.1016/j.epsc.2017.08.003_bib11
  article-title: Hydatid cyst of the pancreas : a case report with 5 years' follow-up
  publication-title: Pediatr Surg Int
  doi: 10.1007/s003830050677
  contributor:
    fullname: Arikan
– volume: 17
  start-page: 188
  issue: 2
  year: 2000
  ident: 10.1016/j.epsc.2017.08.003_bib12
  article-title: Hydatid cysts of the pancreas
  publication-title: Dig Surg
  doi: 10.1159/000018829
  contributor:
    fullname: Wani
– volume: 30
  start-page: 27
  year: 1991
  ident: 10.1016/j.epsc.2017.08.003_bib4
  article-title: Le kyste hydatique du pancréas: à propos d’une observation
  publication-title: Méd Maghreb
  contributor:
    fullname: Errougani
– volume: 45
  start-page: 379
  issue: 5
  year: 2009
  ident: 10.1016/j.epsc.2017.08.003_bib8
  article-title: Unusual location of hydatid cysts in pediatric patients
  publication-title: Pediatr Neurosurg
  doi: 10.1159/000260908
  contributor:
    fullname: Dagtekin
– volume: 5
  start-page: 121
  issue: 2
  year: 1995
  ident: 10.1016/j.epsc.2017.08.003_bib9
  article-title: Hydatid cyst of the pancreas—a case report in a child
  publication-title: Eur J Pediatr Surg
  doi: 10.1055/s-2008-1066184
  contributor:
    fullname: Brown
SSID ssj0001255933
Score 2.0669641
Snippet Abstract Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old...
Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who...
Primary pancreatic hydatid lesions are very rare with an incidence of less than 1% in the adult population. We report an observation of a 5-year-old girl who...
SourceID doaj
crossref
elsevier
SourceType Open Website
Aggregation Database
Publisher
StartPage 48
SubjectTerms Child
Hydatid cyst
Pancreas
Surgery
Treatment
Title Primary hydatid cyst of the pancreas
URI https://www.clinicalkey.es/playcontent/1-s2.0-S2213576617301355
https://dx.doi.org/10.1016/j.epsc.2017.08.003
https://doaj.org/article/5a3a5d3d81744959b7fc83a1ee606a93
Volume 26
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://sdu.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrZ07T8MwEMct6MSCQIAIL2XohiziOE6ckUcrJoQoSIjFOr8EDG1F2qHfvuc4qTrBwpIhcqLzXez7ObL_R8jQQFhpaEaRPQwtaqiptnVJubfcea5ziKUTJtXTu3wYBZmcTamvsCcsygNHx90I4CAstxLRGWG-1pU3kgNzDtEb6qjzmZVbi6n4dwVJua0jn-eMU4TqsjsxEzd3uXkT9AtZ1ep39hWzuqzUivdvJaethDM-IPsdKaa30cJDsuOmR2T4HNUh0s9VOJdgU7NqFunMp8hxKQ7swIDNMXkbj17vH2lX6IAa5KEF5TiScmGxg0w6WXswCA62Mph_uS60NBKEKCGztdAgrQVhWGkM0puvkLiAn5DBdDZ1pyTNCy8BNGADV1gOyH8Fs97kBhcG1uuEXPcdVfNoseo3en2r4BYV3KJCbcqMJ-Qu-GLTMmhRtzcwQqqLkPorQgmpek-q_rgnTlCu6UZLo5hqcpWpSYhVCBUL0w6CUELE5skOCGKiRyO-fjH77D_MPid74ZXx3OEFGSx-lu6S7DZ2edV-a3j9EC9rQbrVbQ
link.rule.ids 315,782,786,866,2106,27933,27934
linkProvider Directory of Open Access Journals
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Primary+hydatid+cyst+of+the+pancreas&rft.jtitle=Journal+of+pediatric+surgery+case+reports&rft.au=El+Bakkaly%2C+A&rft.au=Merouane%2C+N&rft.au=Dalero%2C+O&rft.au=Oubeja%2C+H&rft.date=2017-11-01&rft.issn=2213-5766&rft.eissn=2213-5766&rft.volume=26&rft.spage=48&rft.epage=50&rft_id=info:doi/10.1016%2Fj.epsc.2017.08.003&rft.externalDBID=ECK1-s2.0-S2213576617301355&rft.externalDocID=1_s2_0_S2213576617301355
thumbnail_m http://sdu.summon.serialssolutions.com/2.0.0/image/custom?url=https%3A%2F%2Fcdn.clinicalkey.com%2Fck-thumbnails%2F22135766%2FS2213576616X0022X%2Fcov150h.gif