Presentation
An elderly patient presented for routine abdominal ultrasonography revealed multiple solid hepatic lesions suspected for metastasis follow up CT examination is done.
Patient Data
A well defined small, heterogeneously and prominently peripherally enhancing soft tissue attenuation mass, measuring approximately 2.8 cm is seen in the tail of the pancreas. The lesion shows surrounding fat stranding, representing desmoplastic reaction. Lesion abuts the adjacent splenic vein with loss of intervening fat planes and appear to invade into the splenic vein and migrates medially around 15 mm within the splenic vein, appears as a filling defect. The spleen also shows ill-defined hypodense areas in the upper pole, that signifies splenic vein obstruction.
There are multiple, round to oval, hypoattenuated mildly enhancing lesions are seen in both the lobes of liver suggestive of metastatic lesions.
Case Discussion
Pancreatic malignancies tend to invade the liver via the spleno-portal route and adenocarcinoma of pancreas is known for vascular in-grow, which confers non-resectability of the tumor. In cases where the splenic vein is not well visualized, an indirect sign of splenic vein obstruction is hypodense areas in the splenic parenchyma.
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