Open AccessChronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach
Author(s) -
Kristy Marie Wolske,
Janardhana Ponnatapura,
Orpheus Kolokythas,
Lauren M. Burke,
Rafel Tappouni,
Neeraj Lalwani
Publication year - 2019
Publication title -
radiographics
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 1.866
H-Index - 172
eISSN - 1527-1323
pISSN - 0271-5333
DOI - 10.1148/rg.2019190011
Subject(s) - medicine , autoimmune pancreatitis , pancreatitis , pancreatic duct , radiology , malignancy , differential diagnosis , pancreas , pancreatic mass , duct (anatomy) , pancreatic cancer , pancreatitis, chronic , pathology , cancer
Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacks are available for this article. © RSNA, 2019.