Which features render this tumour unresectable?
Tumour contact with coeliac trunk or SMA of over 180°. In this case, both are surrounded circumferentially by the tumour. It also appears that tumour infiltration of the SMV and splenic vein does not leave clear venous ends for replacement surgery.
Pancreatic neck soft tissue mass slightly hypodense to the pancreas, completely encasing the coeliac trunk and SMA as well as surrounding and narrowing the splenic vein and SMV near the portal confluence. The common bile duct and main pancreatic duct are not dilated.
Several small cystic dilatations along the main pancreatic duct, possibly IPMN. The pancreatic body and tail are atrophied.
Hepatic hilar lymphadenopathy measuring up to 22 mm (short axis) and hepatogastric ligament lymphadenopathy. No evidence of hepatic spread.
Findings are consistent with unresectable pancreatic adenocarcinoma.The coeliac trunk is narrow (stenotic?) at its origin.