A large heterogeneous mass arising from the head of the pancreas is present which abuts the superior mesenteric artery over more than 180 degrees and results in narrowing. The upper aspect of the superior mesenteric vein and origin of the main portal vein are also stenosed. A biliary stent is in situ with associated pneumobilia. The main pancreatic duct is markedly dilated and pancreatic parenchyma is atrophic. Numerous enlarged retroperitoneal nodes are present.