Groove pancreatitis: a mimicker of pancreatic cancer

Congress:

ECR 2018

Poster Number:

C-2077

Type:

Educational Exhibit

Keywords:

Abdomen, Pancreas, Gastrointestinal tract, CT, MR, Diagnostic procedure, Contrast agent-intravenous, Inflammation, Cancer, Cysts

Authors:

A. Rovithi, E. MANAVI, A. Mimila, A. Xinou, D. Panagiotopoulou-Mpoukla; Thessaloniki/GR

DOI:

10.1594/ecr2018/C-2077

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2077

Fig. 1: Pictorial illustration of paraduodenal pancreatitis(PP)depicting a...

Fig. 8: MRI findings of pure form of Groove pancreatitis

Fig. 5: Evolution of the pure form of Groove pancreatitis over time

Fig. 6: CT findings of segmental form of Groove pancreatitis (axial and coronal...

Fig. 7: Evolution of the segmental type of Groove pancreatitis over time (axial and...

Fig. 13: Groove pancreatitis: important imaging clues for differential diagnosis

Learning objectives

1. To illustrate the radiological manifestations of groove pancreatitis and their evolution over time 2. To provide imaging clues for the differentiation between groove pancreatitis and pancreatic adenocarcinoma

Background

The pancreaticoduodenal groove (PDG) is a small theoretic space defined : Medially by the pancreatic head, Laterally by the second portion of the duodenum (D), Posteriorly by the third portion of the duodenum (D) and inferior vena cava, Superiorly by the duodenal bulb. The distal common bile duct (CBD), main pancreatic duct (MPD), accessory pancreatic duct, major papilla, and minor papilla (MP) are found in the pancreaticoduodenal groove. A number of small arteries and veins lie within this space, the most important of which is...

Findings and procedure details

Computed Tomography (CT) is an excellent means for visualizing the imaging features of GP [3]. In the pure form a poorly enhancing plate-like hypodense lesion (which may range from ill-defined fat stranding to frank soft tissue) is depicted between the pancreatic head and the duodenum, near the minor papilla [3,5]. This lesion shows delayed enhancement which is due to delayed blood circulation, caused by fibrous tissue proliferation and secondary arteries constriction. Duodenal wall thickening and stenosis as well as cystic-like lesions of variable sizes in...

Conclusion

It is important for the radiologists to become familiar with imaging findings that are suggestive of groove pancreatitis, since it can mimic pancreatic adenocarcinoma, whose prognosis and treatment is radically different.

Personal information

References

1. Hernandez-Jover D, Pernas J.C., Gonzalez –Ceballos S, et al. Pancreatoduodenal junction: review of anatomy and pathologic conditions. J Gastrointest Surg. 2011;15:1269–1281 2. Stolte M, Weiss W, Volkholz H, Rösch W.A special form of segmental pancreatitis: “groove pancreatitis”. Hepatogastroenterology. 1982;29(5):198–208 3. Triantopoulou C, Dervenis C, Giannakou N, et al. Groove pancreatitis: a diagnostic challenge. Eur Radiol 2009;19:1736–1743 4. Kim JD, Han YS, Choi DL. Characteristic clinical and pathologic features for preoperative diagnosed groove pancreatitis. J Korean Surg Soc 2011;80:342–347 5. Raman SP, Salaria SN, Hruban...