Pancreatic calcifications

Pancreatic calcifications can arise from many etiologies.

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 pediatric population
• hemochromatosis 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 tumors
  • islet cell tumors: especially non-functional tumors; 20% islet cell tumors
  • calcified metastasis
    • colon
    • renal
  • cystic pancreatic neoplasms
    • mucinous (macrocystic) cystadenomas and carcinomas: mucus in tumor 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 / hemangioma (multiple phleboliths) ⁵

Note: 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