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Incomplete annular pancreas in a patient with secondary hemochromatosis

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

History of hematemesis in a patient known for idiopathic medullary aplasia with frequent transfusions.

Patient Data

Age: 25 years
Gender: Male

The liver is enlarged (21 cm) with diffuse and homogenenous increase in liver density (mean density = 90 HU). The portal vessels and hepatic veins appear of low attenuation relative to the liver on non-contrast CT.

Two soft tissue nodules of the medial and lateral wall of the 2nd part of the duodenum in continuity with the pancreas and showing the same enhancement on arterial and portal phase as the normal pancreatic tissue.

Bilateral small inguinal lymphadenopathy is noted.

Case Discussion

CT features most consistent with an incomplete annular pancreas in a patient with a history of frequent blood transfusions for idiopathic medullary aplasia, leading to secondary hemochromatosis.

An upper GI endoscopy was performed that revealed a peptic duodenal ulcer which is considered one of the clinical presentations of the annular pancreas.

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