Learning objectives
The ‘inflammatory mass’ of Paraduodenal Pancreatitis is a generic diagnosis that only a radiologist can suggest and a pathologist can characterize.
And,
it is uncertain if we as radiologists are paying sufficient attention to this recently described,
relatively less-known,
and often misdiagnosed clinicopathological entity.
This reflection arises from a limited number of studies and reports available in the radiological literature pertaining to this distinct form of chronic pancreatitis.
Additionally,
this becomes particularly relevant,
as the increase in alcohol consumption globally,
is expected to escalate the...
Background
PARADUODENAL PANCREATITIS
Paraduodenal pancreatitis recently described in2004byAdsay and Zambonirefers to a distinct form of chronic pancreatitis occurring predominantly in and around the duodenum along theminor-papilla
(Fig-1).
This is anumbrella-termused for various conditions which previously had a variety of names,
including cystic dystrophy of pancreas,
para-duodenal wall cyst,
groove pancreatitis,
pancreatic duodenal hamartoma,
and myoadenomatosis (Fig-2).
ETIOPATHOGENESIS:
Adisturbance of the flowof pancreatic juice through theSantorini ductand presence ofheterotopic pancreatic tissuewithin the duodenal wall has been implicated as important contributory factors.
Pathogenetically,
key factors areanatomical or functional...
Imaging findings OR Procedure details
IMAGING MANIFESTATIONS:
Paraduodenal pancreatitis manifests as either cystic lesions (cystic variant) or a solid-mass occurring predominantly in and around the minor papilla (solid variant) (Fig-7).
IMAGING MODALITIES:
Endoscopic ultrasongraphy (EUS) and MRCP are considered the preferred imaging modalities amongst various options available including magnetic resonance imaging (MRI),
computed tomography (CT) and trans-abdominal ultrasonography.
ABDOMINAL ULTRASONOGRAPHYmay be able to sometines demonstrate:
A hypoechoic mass adjacent to the pancreatic head with
Thickening of the second part of the duodenum.
CT SCANcan reflect the histological characteristics of the...
Conclusion
The terms ‘cystic dystrophy of heterotopic pancreas,’ ‘groove pancreatitis,’ ‘pancreatic hamartoma of duodenum,’ ‘paraduodenal wall cyst’ and ‘myoadenomatosis’ are now classified as Paraduodenal Pancreatitis.
These patients have clinical characteristics similar to those of chronic pancreatitis.
Diagnostic imaging modalities of choice are endoscopic ultrasonography and MRI with MRCP,
and,
the characteristic imaging findings include a solid or cystic pattern corresponding to the path of the duct of Santorini/minor papilla (groove region) with thickening of the duodenal wall.
A painful solid and/or cystic lesion along the pancreatic...
References
This exhibit was presented at ESGAR 2012 and is being re-presented with permission from ESGAR.
Arora A,
et al.
Paraduodenal pancreatitis: a radiologically less known entity! E-posterEE-128.23rd Annual Meeting of ESGAR,
Edinburgh,
UK,
June 12-15,
2012.
REFERENCES:
Arora A,
Mukund A,
Thapar S,
Jain D (2011) Paraduodenal pancreatitis.
10.1594/EURORAD/CASE.9436.
Arora A,
Mukund A,
Thapar S,
Jain D (2011) Cystic dystrophy of the duodenal wall.
10.1594/EURORAD/CASE.9429.
Arora A,
Mukund A,
Thapar S,
Jain D (2011) Groove pancreatitis: CT,
MRI & MRCP findings.
10.1594/EURORAD/CASE.9404.
Adsay NV,
Zamboni...
Personal Information
ANKUR ARORA,MD,
DNB,
FRCR,
EDiR
Assistant Professor
Department of Radiology/ Interventional Radiology
Institute of Liver & Biliary Sciences (ILBS)
D-1 Vasant Kunj,
New Delhi-110070,
India
E mail:
[email protected]