Pancreatic calcifications can arise from many aetiologies.

Punctate intraductal calcifications

• chronic pancreatitis

  • alcoholic pancreatitis (20-40%) ² 

    • intraductal, numerous, small, irregular

    • preponderant cause of diffuse pancreatic intraductal calcification

  • gallstone pancreatitis (2%) ²

    • ^​much less commonly associated with calcifications

  • hyperparathyroidism (10%) ²

    • most also have nephrocalcinosis or urolithiasis (70%)

• kwashiorkor ²

  • calcifications are common

  • manifest in the paediatric population

• haemochromatosis ⁵

• idiopathic: no underlying cause can be determined

Smaller intraductal calcifications

• senile 

  • usually in patients aged over 70 years

  • scattered

  • number of calcifications increase with age

• cystic fibrosis: finely granular calcifications in smallest ducts in end stage disease with pancreatic failure

• atherosclerotic calcifications

• chronic pancreatitis

Larger intraductal calcifications

• hereditary pancreatitis

  • autosomal dominant 9% penetrance

  • large rounded shape

  • peaks at 5-17 years

• chronic pancreatitis

• gallstone migration

• tropical pancreatitis: young patients in tropical countries

Dystrophic calcification

• old insult

  • old infection

  • old infarction

  • old trauma

• pancreatic tumours

  • islet cell tumours: especially non-functional tumours; 20% islet cell tumours

  • calcified metastasis

    • colon

    • renal

  • cystic pancreatic neoplasms

    • mucinous (macrocystic) cystadenomas and carcinomas: mucus in tumour rarely calcifies; cysts >2 cm

    • serous (microcystic) cystadenomas and carcinomas: commonly calcify, characteristically as a central calcified scar with radiating calcified septations

    • intraductal papillary mucinous neoplasms: widened pancreatic duct extensive mucus

    • solid and pseudopapillary epithelial neoplasm

      • rare: in young women, commonly calcifies,  characteristically punctate, peripheral calcifications

    • pancreatoblastoma: rare. ~ 20% calcify

    • cavernous lymphangioma / haemangioma (multiple phleboliths) ⁵

NB: adenocarcinomas of the pancreas do not generally calcify; rather, they typically engulf previously present adjacent calcifications.

Pancreatic calcification mimics

• atherosclerosis of splenic artery and intrapancreatic arterioles

• oral contrast in duodenal diverticula