Presentation
Right upper abdominal pain with jaundice.
Patient Data
Diffuse enlargement of the pancreas with loss of definition of the pancreatic clefts giving a "sausage-shaped pancreas" with a peripancreatic rim of low attenuation "halo" and moderate enhancement on postcontrast images. No peripancreatic fat stranding or fluid collection is seen. Peripancreatic lymph nodes (12 mm). distended gallbladder with dilatation of pancreatic and biliary ducts and concentric thickening with the enhancement of the CBD (cholangitis).
Umbilical hernia of omental content.
MRI performed 3 weeks later demonstrates the same features.
The pancreas is diffusely enlarged ("sausage-shaped pancreas") with decreased signal intensity on T1, and increased signal intensity on T2, mainly of the pancreatic head which shows areas of restricted diffusion. Delayed parenchymal enhancement on dynamic sequences with a peripancreatic rim of low signal "halo" well-demonstrated on postcontrast sequences. The gallbladder is distended with persistent dilatation of the pancreatic duct as well as the intra-and extrabiliary ducts.
MRI performed 4 months following treatment with steroids shows a significant improvement with decreased volume of the pancreas with however persistence of inhomogeneous enhancement. The gallbladder is of normal size with no significant dilatation of the intra- or extrahepatic biliary ducts.
Case Discussion
CT and MRI features most consistent with autoimmune pancreatitis (histologically proven by endoscopic ultrasound-guided biopsy) with significant improvement under corticosteroid therapy.
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