Presentation
Abdominal discomfort.
Patient Data
Expansion of the pancreas head, neck, and proximal body with infiltrative low-attenuation soft tissue, broadly contacting the posterior antrum, pylorus, and duodenal bulb. Atrophy of the remainder of the pancreas body and tail with mildly dilated duct. Midlly dilated central bile ducts and gallbladder. Invasion and narrowing of the portosplenic confluence with small amount of thrombus in the main portal vein. Some hazy soft tissue tumor abuts the SMA proximally. Fusion anomaly of the left kidney.
Case Discussion
Typical appearance of a larger pancreas head/neck adenocarcinoma on portal venous phase CT, will ill-defined soft tissue appearance that enhances less than the uninvolved pancreas. At first glance, you might consider pancreatitis as a diagnosis - particularly necrotizing pancreatitis. However, notice the lack of inflammation surrounding the pancreas, the atrophic body/tail indicating the sequelae of ductal obstruction, and the invasion into the portal splenic confluence, which are all features supporting tumor over acute/subacute inflammation. The diagnosis of adenocarcinoma was confirmed with endoscopic biopsy.
Unable to process the form. Check for errors and try again.