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Pancreatic adenocarcinoma (T4)

Case contributed by Dr Frank Gaillard
Modality: CT

Large ill-defined low-density solid mass in head of pancreas and uncinate process which measures 3.0 cm transversely and 4.0 cm vertically. The surrounding peripancreatic fat demonstrates some stranding and nodularity, suggestive of infiltration. The mass encases the superior mesenteric vein and the superior mesenteric artery, tracking posteriorly to abut the aorta. Marked dilatation of the intra and extra-hepatic bile ducts, pancreatic duct and gallbladder is consistent with duct obstruction. Small amount of fluid around the gallbladder. No ascites elsewhere. No liver lesions. No retroperitoneal lymphadenopathy. No destructive bone lesions.

Other findings are as follows: - 3 mm diameter calcified gallstone in gallbladder. - Complex cyst in the anteromedial cortex of the upper pole of right kidney with wall calcification. - Small simple cysts in left kidney. - Dilated calyx in midpole of right kidney with thin overlying parenchyma consistent with focal scarring. - Marked lumber scoliosis convex to the left.

ERCP

Modality: Fluoroscopy

ERCP was performed demonstrating a shouldered obstruction to the bottom end of the bile duct, which was traversed and stent inserted.

Case Discussion:

Typical appearances of a locally advanced pancreatic head obstruction with double duct sign.

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