Imaging Approach to the Pancreas

(Left) Graphic shows the ventral pancreatic anlagen developing as an outpouching of the hepatic-biliary diverticulum. As the stomach and duodenum elongate, the ventral pancreas and bile ducts rotate clockwise and posteriorly to fuse with the dorsal pancreas.

(Right) ERCP of pancreatic divisum shows that the main and accessory pancreatic ducts do not communicate. This results embryologically from failure of fusion of the ducts between the dorsal and ventral pancreatic anlagen.

(Right) ERCP of pancreatic divisum shows that the main and accessory pancreatic ducts do not communicate. This results embryologically from failure of fusion of the ducts between the dorsal and ventral pancreatic anlagen.

(Left) Axial CECT shows normal senescent changes within the pancreas . The top image (A) is from a 30-year-old woman and the bottom image (B) is from a 78-year-old man. With aging, the pancreas decreases in size with increased fatty lobulation. Small calcifications and mild ductal dilatation may also be seen.

(Left) Axial CECT shows normal senescent changes within the pancreas . The top image (A) is from a 30-year-old woman and the bottom image (B) is from a 78-year-old man. With aging, the pancreas decreases in size with increased fatty lobulation. Small calcifications and mild ductal dilatation may also be seen.

(Right) Coronal reformatted CECT shows the relationship of the pancreatic head to the 2nd portion of the duodenum .

(Right) Coronal reformatted CECT shows the relationship of the pancreatic head to the 2nd portion of the duodenum .

(Left) In this elderly man with painless jaundice, axial CECT shows a hypodense mass in the head of the pancreas and a distended gallbladder .

(Left) In this elderly man with painless jaundice, axial CECT shows a hypodense mass in the head of the pancreas and a distended gallbladder .

(Right) Coronal CT reformation in the same case shows the dilated pancreatic duct interrupted as it enters the hypodense mass , a typical presentation of pancreatic ductal carcinoma.

(Right) Coronal CT reformation in the same case shows the dilated pancreatic duct interrupted as it enters the hypodense mass , a typical presentation of pancreatic ductal carcinoma.

(Left) This 35-year-old man presented with jaundice and weight loss, with axial CECT showing a hypodense mass in the head of the pancreas causing biliary obstruction and dilation of the gallbladder .

(Left) This 35-year-old man presented with jaundice and weight loss, with axial CECT showing a hypodense mass in the head of the pancreas causing biliary obstruction and dilation of the gallbladder .

(Right) Curved planar reformation of CECT in the same case shows the pancreatic “mass” causing partial obstruction of the bile duct , while the pancreatic duct is only mildly dilated. Further evaluation, including biopsy, confirmed a diagnosis of autoimmune (IgG4-related) pancreatitis.

(Right) Curved planar reformation of CECT in the same case shows the pancreatic “mass” causing partial obstruction of the bile duct , while the pancreatic duct is only mildly dilated. Further evaluation, including biopsy, confirmed a diagnosis of autoimmune (IgG4-related) pancreatitis.

(Left) In this 81-year-old man with painless jaundice, a curved planar reformatted CECT shows dilation of the common bile duct and pancreatic duct due to a small hypodense ampullary carcinoma .

(Left) In this 81-year-old man with painless jaundice, a curved planar reformatted CECT shows dilation of the common bile duct and pancreatic duct due to a small hypodense ampullary carcinoma .

(Right) Coronal 3D reformatted CT in the same case clearly shows the dilated bile duct , pancreatic duct , and ampullary tumor .

(Right) Coronal 3D reformatted CT in the same case clearly shows the dilated bile duct , pancreatic duct , and ampullary tumor .

(Left) In this 63-year-old man with intractable peptic ulcers, axial CECT shows a thick-walled, hyperemic stomach .

(Left) In this 63-year-old man with intractable peptic ulcers, axial CECT shows a thick-walled, hyperemic stomach .

(Right) Arterial phase CT in the same case shows a subcentimeter mass in the pancreatic head that proved to be a gastrinoma (1 type of pancreatic endocrine tumor) that was responsible for this patient’s Zollinger-Ellison syndrome.

(Right) Arterial phase CT in the same case shows a subcentimeter mass in the pancreatic head that proved to be a gastrinoma (1 type of pancreatic endocrine tumor) that was responsible for this patient’s Zollinger-Ellison syndrome.

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Tags: Diagnostic Imaging Gastrointestinal

Nov 16, 2016 | Posted by admin in GASTROINTESTINAL IMAGING | Comments Off

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