RADIOLOGY CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG

1. 83Solid Pancreatic Masses on
Computed Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 83-1 Pancreatic carcinoma. (A)
Noncontrast scan demonstrates a
homogeneous mass (M) in the body of the
pancreas. (B) Contrast-enhanced scan at the
time of maximum aortic contrast shows
enhancement of the surrounding vascular
structures and normal pancreatic
parenchyma, while the pancreatic carcinoma
remains unchanged and thus appears as a
low-density mass.162

4. • Fig GI 83-2 Pancreatic carcinoma (rapid growth and arterial
encasement). (A) Initial scan demonstrates a focal change
in the shape of the ventral contour of the pancreas at the
junction of the body and head (arrow). There is no
enlargement of the pancreatic tissue. This was initially
interpreted as representing an anatomic variant. (B) Three
months later, a repeat scan shows a focal tumor mass
(closed arrow) in the location of the focal contour
abnormality seen in (A). A dynamic CT scan after the
intravenous bolus injection of contrast material
demonstrates the splenic and hepatic arteries at the base
of the tumor. Note that the hepatic artery (open arrow) has
an irregular contour. Arteriography showed encasement by
this unresectable tumor.162

5. • Fig GI 83-3 Insulinoma. Contrast scan demonstrates a
homogeneously enhancing mass (arrow) in the neck of
the pancreas in an elderly man who presented with
life-threatening hyperglycemia.170

6. • Fig GI 83-4 Vipoma. Contrast scan in an elderly
man with watery diarrhea shows a huge mass
with internal septa and calcification in the body
and tail of the pancreas.170

7. • Fig GI 83-5 Islet cell tumor (nonfunctioning).
Coronal CT image shows a large mass (arrow)
in the left upper quadrant replacing the
pancreas and invading the portal vein.170

8. • Fig GI 83-6 Solid and papillary epithelial
neoplasm. (A) Contrast CT scan shows a mixed
solid and cystic mass in the pancreatic head
(arrows). (B) Axial T1-weighted MR image
shows areas of high signal intensity due to
hemorrhage within the mass (arrow).171

9. • Fig GI 83-7 Metastatic renal cell carcinoma.
Multiple enhancing nodular masses (arrows)
in the pancreatic body and tail.172

10. • Fig GI 83-8 Peripancreatic lymph node
metastases. Massive nodal enlargement (arrows)
with obliteration of fat planes between the mass
and the head of the pancreas.

11. Fig GI 83-9 Lymphoma. Huge mass infiltrating the head of the
pancreas (straight arrows). The curved arrow points to stones in
the gallbladder.

12. • Fig GI 83-10 Acute pancreatitis. Diffuse enlargement of the
pancreas (P) with obliteration of peripancreatic fat planes by the
inflammatory process. Note the extension of the inflammatory
reaction into the transverse mesocolon (arrows).173

13. • Fig GI 83-11 Acute gallstone pancreatitis. (A)
There is enlargement of the head of the
pancreas (P) with inflammatory reaction
surrounding peripancreatic fat planes (arrow).
(B) A stone (white arrow) is seen in the
gallbladder and the common bile duct is
enlarged (black arrow).

14. • Fig GI 83-12 Chronic pancreatitis. There is
pancreatic atrophy along with multiple
intraductal calculi and dilatation of the pancreatic
duct (arrow). The calcifications were not seen on
plain abdominal radiographs.122

15. • Fig GI 83-13 Pancreatic abscess. There is a gascontaining abscess
(small arrows) in the pancreatic bed, with marked anterior
extension (large arrow) of the inflammatory process.

16. • Fig GI 83-14 Pancreatic abscess after a gunshot wound.
There are multiple intrapancreatic and peripancreatic gas
bubbles (closed arrows), bullet fragments (open arrows), a
small renal laceration, and an extrarenal hematoma (H).89

17. • Fig GI 83-15 Cystic fibrosis. Contrast scans at
the level of the pancreatic tail (A) and head (B)
show complete replacement of the pancreatic
parenchyma by fat (arrows). There is also
enlargement of the spleen.174

18. • Fig GI 83-16 Pancreatic cystosis. (A) Contrast CT scan
shows multiple cysts (*) in the region of the pancreas
(P), which is completely replaced by fibrofatty tissue.
The cyst walls have a somewhat higher attenuation
than the musculature. The lesion is located along the
splenic vein (Sv), and its most lateral part is situated
between the left kidney (K) and the spleen (S).175 (B)
T2-weighted MR image in another patient shows
innumerable cysts (arrows) replacing the pancreatic
parenchyma.174

19. • Fig GI 83-17 Normal enhanced duodenum. (A)
Initial CT scan shows findings that suggest
enlargement of the head of the pancreas (*).
(B) Repeat scan obtained with additional
contrast material shows a normal pancreatic
head, with contrast material in the duodenum
(arrow) and gallbladder (*).174

20. • Fig GI 83-18 Annular pancreas. Pancreatic
tissue surrounds the duodenum (*).174

21. Fig GI 83-19 Venous vascular lesion. Occlusive portal vein
thrombus (arrow). When this extensive, this finding may be
mistaken for a mass.174

22. • Fig GI 83-20 Mesenteric tumor-like disease.
(A) Carcinoid tumor appears as a
heterogeneously attenuating mass with
calcifications (*) adjacent to the head of the
pancreas in the root of the mesentery. (B)
Desmoid tumor presents as a large, ovoid
mass compressing the pancreas dorsally (*).
Both of these tumors simulate lesions of
pancreatic origin.174

23. • Fig GI 83-21 Gastric GIST. (A) Initial scan shows
an apparent large mass (*) abutting the tail of
the pancreas. (B) Focused pancreatic scan
shows a sulcus between the mass (*) and the
pancreatic tail (arrow), suggesting an
extrapancreatic origin for the mass.174