Wk 2, Case 4 - Review

PATIENT HISTORY: Pancreatic tail mass seen on ultrasound

Study: CT abdomen and pelvis with intravenous contrast.

INDICATION: Pancreatic tail mass seen on ultrasound.

COMPARISON: None.

TECHNIQUE: CT images of the abdomen and pelvis were obtained after the administration of intravenous contrast. Images of the abdomen were obtained in the pancreatic and portal venous phase while images of the pelvis are obtained in the portal venous phase only.


FINDINGS:

Lung bases: Visualized lung bases are clear.

Hepatobiliary: A right hepatic hypodensity is too small to characterize.

Gallbladder is unremarkable. There is no biliary ductal dilatation.

Pancreas: There is a partially calcified enhancing mass centered in the body of the pancreas measuring 1.7 cm compatible with a neoplasm. Posterior and cephalad to this, there is an additional 1.5 cm mass which appears separate from this lesion, presumably an adjacent peripancreatic node. No dilatation of the pancreatic duct is seen.

Spleen: Unremarkable.

Adrenal glands: Unremarkable.

Kidneys: Unremarkable.

Bowel: No bowel obstruction.

Abdominal and pelvic lymph nodes: Possible peripancreatic node adjacent to the pancreatic mass as described. No additional adenopathy seen.

Peritoneum: No ascites.

Vasculature: No abdominal aortic aneurysm. The splenic vein is posterior and inferior to the pancreatic mass, with a portion of it intimately associated with the lesion though no direct invasion is seen, and the vessel is patent. The superior mesenteric vein is patent. The celiac, superior mesenteric and common hepatic arteries are widely patent. The splenic artery is interposed between the pancreatic mass and peripancreatic node.

Pelvis: No mass.

Musculoskeletal system and soft tissue: No aggressive osseous lesion.


IMPRESSION:

Pancreatic mass with adjacent adenopathy as described. Given the calcifications, relative hypervascularity and lack of pancreatic ductal dilatation, this is favored to represent a neuroendocrine tumor. Endoscopic ultrasound is suggested for further evaluation.