Learning objectives
To discuss laboratory and clinical data regarding the pancreas that may be useful for radiologists to elaborate differential diagnosis of pancreatic conditions.
To illustrate the imaging features of pseudo-tumoral forms of pancreatic conditions.
Background
Despite advances in pancreatic imaging, the unequivocal identification of a non-neoplastic process is still difficult.
Pancreatic pseudo-lesions represent a group of distinct categories that may range from benign enlargement of the gland, which clinically resembles a true neoplasm to anatomical variants and benign pathology.
Together with imaging features, radiologists can support their diagnostic differential with the support of laboratory and clinical data.
Findings and procedure details
1-Pancreatic laboratory tests and clinical approach in specific contexts:
1.1-Acute pancreatitis (AcP)[Fig 1]:
1.1.1.Symptoms:
- Epigastric and periumbilical pain;may radiate to the back, chest, flanks, and lower abdomen.
- Nausea, vomiting, and abdominal distention.
- Distress and anxiety.
- Fever, tachycardia, and hypotension.
1.1.2.Physical Examination:
- Abdominal tenderness.
- Jaundice (infrequent): edema of the head of the pancreas or biliary stones/sludge.
- Basilar rales, atelectasis, pleural effusion (left-sided).
- Erythematous skin nodules.
- Diminished bowel sounds.
- Enlarged pancreas palpable.
- Cullen’s sign: blue discoloration...
Conclusion
Radiologists should be familiarized with clinical and laboratory data regarding pancreatic conditions, especially in the diagnose of pancreatic pseudotumors. Awareness of the most frequent conditions, their imaging spectrum, and clinical context may help trigger adequate diagnostic and therapeutic workup precluding unnecessary tests or procedures, including surgery.
Personal information and conflict of interest
C. T. Rodrigues:
Nothing to disclose
N. M. F. Campos:
Nothing to disclose
A. A. Ferreira:
Nothing to disclose
M. A. Portilha:
Nothing to disclose
L. Curvo-Semedo:
Nothing to disclose
F. Caseiro Alves:
Nothing to disclose
P. Donato:
Nothing to disclose
References
[1]Joseph K. T. Lee et al. 2019. Computed Body Tomography with MRI Correlation. Lippincott Williams & Wilkins.
[2]Semelka, R. C. 2011.Abdominal-Pelvic MRI. Wiley.
[3]Katherine J. To’o et al. 2005.Pancreatic and Peripancreatic Diseases Mimicking Primary Pancreatic Neoplasia.RadioGraphics.