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.



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

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(Left) Axial CECT shows normal senescent changes within the pancreas image. 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.


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

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


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

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


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

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


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

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


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(Right) Arterial phase CT in the same case shows a subcentimeter mass image 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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Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Imaging Approach to the Pancreas

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