0:01

So, we have another case, a challenging

0:02

case here, where the patient is presenting

0:05

with dilated CBD and obstructive jaundice.

0:11

So, remember I just mentioned that a case of

0:14

groove pancreatitis usually doesn't present

0:16

with obstructive jaundice or dilated CBD.

0:20

And then we see ductal dilatation here,

0:23

atrophic pancreas, and then the pancreatic duct

0:27

demonstrates abrupt cut off along with the CBD.

0:32

We can find these findings

0:33

better maybe on Coronel.

0:35

So, dilated CBD, dilated PD, abrupt cut

0:41

off, and then we have a pseudomass-like

0:44

area or mass-like area in the pancreatic

0:46

head, which demonstrates multiple cystic

0:50

lesions in the pancreatic adrenal groove.

0:54

And this case was called groove

0:57

pancreatitis from outside hospital on CT scan.

1:01

And that came to our hospital, and we did MR,

1:04

and we found a similar kind of cystic degeneration

1:07

along with the pancreatic head,

1:09

but see the findings we discussed before.

1:11

None of these findings, there is

1:12

no side branch dilatation here.

1:14

And remember if it is groove

1:15

pancreatitis, it should involve just

1:17

the pancreatic head and the groove.

1:19

Why the rest of the pancreas is involved?

1:23

So having pancreatic atrophy, dilated duct,

1:26

with double duct sign, with abrupt cut

1:28

off, it already leans towards cancer.

1:32

Seeing these cystic changes along with the

1:34

periphery of the mass or in the adrenal groove

1:36

doesn't make any difference

1:39

because you can still have pancreatitis

1:41

in the patient with underlying cancers.

1:44

So if the patient presents with acute pancreatitis

1:46

and you find cancer underlying, that can happen.

1:49

So in this particular case, after seeing

1:51

these two or three signs, I lean towards cancer rather

1:54

than groove pancreatitis, and

1:57

let's see how it looks on arterial phase.

2:02

And we see lots of cystic

2:03

changes in the pancreatic head.

2:05

All of the area there is hypointense.

2:08

And if we pay attention to the

2:09

vessels, they are looking clean.

2:12

SMA, it is mostly clean, there is fat

2:16

maintained along with the periphery.

2:18

If we pay attention to the SMV and the portal

2:21

vein, portal vein appears slightly smaller

2:26

in size, but it is patent throughout, and then

2:30

we see the size of SMA is smaller than SMV.

2:35

So overall, given these imaging appearances,

2:38

let us go to the delayed phase for a second

2:39

and see how it looks on the delayed phase.

2:43

And here we see actually the SMV is kind of bit

2:46

compromised in caliber by this so-called lesion.

2:50

So overall, given these findings,

2:56

we lean towards it is a cancer rather than a

2:58

groove pancreatitis, despite it was called

3:00

as groove pancreatitis by an outside scan,

3:04

and this turned out to be a real cancer.