Fishtail pancreas (pancreas bifidum) and circumaortic left renal vein
Presentation
Underlying rectosigmoid adenocarcinoma, post surgery and chemotherapy. Right-sided abdominal pain.
Patient Data
Surgical sutures at upper rectum in keeping with anastomotic site. No enhancing mass in this region.
Evidence of cholecystectomy with surgical clips in the gallbladder fossa.
New enhancing liver lesions. Similar small hypodense lesion in the spleen. Tiny bilateral renal cortical cysts.
Bifid pancreatic tail. Rest of pancreas is preserved. No focal pancreatic lesion or calcifications. No peripancreatic fat streakiness. Pancreatic duct not dilated.
Incidental findings of left renal vein passing anterior and posterior to the aorta.
Impression:
new hypervascular liver lesions suggestive of liver metastases (disease progression). No evidence of local recurrence
incidental findings of fishtail pancreas and circumaortic left renal vein
Yellow arrow points to the bifid appearance of the pancreatic tail.
Blue arrows point to the left renal vein passing anterior and posterior to the aorta (red arrow).
Case Discussion
Bifid pancreatic tail is a rare anatomical variant which has been found incidentally on CT, MRI, MRCP and autopsy 1-3. Other more common congenital variants include pancreas divisum and annular pancreas.
Another anomaly seen in this patient is the circumaortic left renal vein, passing anterior and posterior to the aorta.
It is important to convey these findings, especially in cases where the patient may need surgery to prevent unanticipated complications.
Unable to process the form. Check for errors and try again.