Pancreatic Lipomatous Pseudohypertrophy

Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR

Key Facts

Imaging

Diffuse enlargement and fatty replacement of pancreas
- Without imaging or clinical signs of cystic fibrosis
- Usually no evidence of ductal obstruction (pancreatic or biliary)

Top Differential Diagnoses

Cystic fibrosis
- Appearance of pancreas is identical to that in lipomatous pseudohypertrophy
- Clinical presentation is very different, starting in childhood
Pancreatic senescent changes
- Also associated with obesity, steroid use
- Pancreatic atrophy but rarely clinically evident or significant
- Usually less mature-appearing fat in pancreas
Pancreatic focal fatty infiltration
- Usually limited to head-uncinate or body-tail segments
- Less evidence of mature fat
Shwachman-Diamond syndrome
- Rare congenital multisystem disease, evident in childhood

Pathology

Associated with chronic advanced liver disease, parkinsonism, COPD

Clinical Issues

Usually incidental finding on CT or in autopsy

(Left) Axial NECT in a 57-year-old woman with alcoholic cirrhosis shows typical cirrhotic morphology of the liver (nodular with widened fissures) and ascites. (Right) Another CT section in the same case shows diffuse enlargement and fatty replacement of the pancreas

that mimics findings seen in cystic fibrosis.

(Left) Axial T1WI C+ FS MR in the same patient shows the lipomatous pseudohypertrophy with diffuse drop out of signal throughout the body of the pancreas

due to fat suppression. (Right) Axial CECT in a 40-year-old man with longstanding Crohn disease shows marked fatty infiltration of the pancreas

but no enlargement of the gland. The patient had no symptoms of pancreatic disease, and the fatty infiltration of the pancreas is believed to be due to chronic steroid use.