Presentation
Significant weight loss of about 12 kg for two months and upper abdominal and back pain
Patient Data
Distal pancreatic atrophy and MPD dilation are visible, but the pancreatic head and neck and proximal MPD appear normal. An infiltrative soft tissue around the vessels is visible at the level of MPD transition. It encases the common hepatic artery, the splenic vessels, portal vein confluence, and adjacent portal trunk, and SMV. SMA abutment suspected. A large hypo-enhancing area in the central part of the liver in segment 4th, 8th, and central part of segment 5th raises the possibility of metastasis. A single large metastasis from pancreatic adenocarcinomas is unusual. Two hypodense lesions with almost fluid density in the caudate lobe suggest liver cysts.
The large hypo-enhancing area in the central part of the liver in segment 4th, 8th and central part of the segment 5th does not show diffusion restriction or mass effect with vessels passing through it undisturbed. It shows signal loss on out phase images suggestive of focal fat infiltration. The distal pancreatic atrophy and MPD dilation, the infiltrative soft tissue encasing the common hepatic artery, splenic vessels, portal vein confluence, and adjacent portal trunk, and SMV are visibly similar to the CT scan. Two hypodense lesions on the caudate lobe which were suggested to be liver cysts on CT scan are two foci of focal fat based on MR images.
Case Discussion
Focal fat infiltration is usually geographic and easily distinguishable from true liver masses, but occasionally it may be round or mass-like. In this setting, chemical shift MRI could be helpful to confirm the diagnosis.
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