Presentation
Personal history of kidney cancer, History of right-sided nephrectomy.
Patient Data
Lower Thorax: Unremarkable.
Hepatobiliary: No focal hepatic lesions. No biliary ductal dilatation.
Spleen: No splenomegaly.
Pancreas: No focal masses or ductal dilatation. The uncinate process of the pancreas extends along the entire aspect of the third part of the duodenum. Normal anatomic variant of horseshoe pancreas.
Adrenals: No adrenal nodules.
Kidneys/Ureters: Status post right nephrectomy. No evidence of recurrent mass at the nephrectomy bed. No left-sided hydronephrosis or stones. Single focus of cortical thinning. Subcentimeter, too small to characterize renal cyst, which likely represents a simple renal cyst and which requires no further follow-up.
Pelvic Organs/Bladder: Small left-sided fat-containing inguinal hernia, prostatomegaly. Thickened appearance of the urinary bladder, similar to prior imaging, right-sided hydrocele.
GI Tract: Diverticulosis without diverticulitis. Moderate amount of stool burden throughout the large bowel. No distention or wall thickening.
Peritoneum/Retroperitoneum: No free air or fluid.
Lymph nodes: No lymphadenopathy.
Vessels: The aortoiliac axis demonstrates scattered atherosclerotic plaque, however appears otherwise unremarkable in course and caliber.
Bones and Soft Tissue:
-Moderate to severe degenerative changes throughout the visualized spine, including osteophyte formation, vacuum disc phenomenon, and joint space narrowing.
-Small fat-containing left inguinal hernia.
-No suspicious osseous lesions.
Case courtesy, Dr. Ross Kuprien
Additional Contributors Dr. Benjamin Jiao, Dr. Samuel Patterson, Jason Paek, Harrison Savarese.
Case Discussion
Horseshoe pancreas is a rare anatomic variant of the pancreas that is largely clinically insignificant, although can be important to note when performing regional surgery. It is characterized by an uncinate process which abnormally extends along the length of the third portion of the duodenum. It is called a 'horseshoe pancreas' because of its visual similarity to a horse shoe.
In patients with previous history of renal cell carcinoma. Special attention should be paid to the post surgical bed to monitor for residual or recurrent malignancy.
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