Presentation
Nonalcoholic nonsmoker, insidious onset of pain in central abdomen, history of vomitting after meals, weighloss, lethargy and loss of appetite: since one year.
Patient Data
CT finding are consistent with infiltrative pancreatic tail mass likely adenocarcinoma, invading the DJ flexure, upper pole of left kidney, left adrenal, encasing and attenuating the left renal artery, vein and splenic artery, with splenic vein thrombosis, multilevel lymphadenopathy, scattered hepatic secondaries and bony metastatic deposit at left ilium.
Diagnosis was biopsy proven .
Case Discussion
Large irregularly marginated peripherally enhancing mass lesion of tail of pancreas, extending into and involving the superior aspect of left kidney and the duodenojenunal flexure causing proximal resultant duodenal obstruction and gastric dilatation. The lesion is encasing the left renal artery and vein and the splenic artery with non-opacified splenic vein ( as seen on delayed images) compatible splenic vein thrombosis. Variably sized mulitple hypodense foci with early peripheral enhancement seen in both lobes of liver which represent secondaries. Mild intrahepatic biliary dilatation with prominent common hepatic and bile duct is likely to be due to extrinsic pressure from large necrotic periportal lymphnodes. Adenopathy is also seen at celiac, peripancreatic, portocaval , periaortic and aortocaval regions.
Left suprarenal gland is also bulky and heterogenous. Spleen shows a hypoattenuating ill defined area at inferomedial pole consistent with splenic invasion
Diffuse soft tissue thickening/cuff is noted around the celiac axic, superior mesenteric & splenic as well as retroperitoneal vasculature suggesting lymphovascular invasion.
Retroperitoneal fat planes are ill defined, with subtle soft tissue thickening along adjacent peritoneal folds, gastrosplenic, and gastrocolic ligaments.
Discrete lytic foci noted at bilateral ilium just paraarticular to the SI joints suggesting bony metastasis,