Pancreatic adenocarcinoma

Case contributed by Dr Craig Hacking

Presentation

RUQ pain and jaundice

Patient Data

Age: 60
Gender: Female
Modality: Ultrasound

Gross intra hepatic duct dilatation affecting both the right and left ductal systems. The common bile duct is also distended measuring up to 12 mm. The common bile duct is however not completely visualised. Within the visualised portion, no choledocholithiasis is identified. The gallbladder is distended although no gallstones or gallbladder wall thickening isidentified. Sonographic Murphy's negative.

The head of the pancreas isnot completely visualised due to overlying bowel gas, however the main pancreatic duct was also distended measuring 5 mm.

The liver demonstrates normal echotexture with no focal liver lesions identified.

Bilateral kidneys have a normal appearance. The spleen is normal.

Conclusion

Intra and extrahepatic duct dilatation as well as dilatation of the main pancreatic duct. The distal portion of the CBD was not visualised and thus no cause for this obstruction is identified on the current ultrasound study. Given the patient's elevated bilirubin level, further evaluation with CT or MR is suggested to better interrogate the region of the ampulla.

3 phase pancreatic protocol

Modality: CT

There is an ill-defined round hypodense mass (3.2 cm in diameter) within the head of the pancreas causing obstruction of both the main pancreatic duct and common bile duct. Medially the lesion abuts the right sided border of the SMV without encasing it and inferiorly abuts the posterior wall of the SMV without encasing it. The anterior border of the lesion is ill-defined with a small amount of adjacent fat stranding and it abuts but does not encase a branch of the SMV (likely right colic vein). The branches of the coeliac trunk are clear from the mass. No other pancreatic lesion is identified.

Enlarged epiploic lymph node measuring 19 x 11 mm. No other lymphadenopathy.

No hepatic metastasis. Extensive intrahepatic bile duct dilatation due to downstream obstruction. The kidneys, spleen and adrenal glands are normal. Bowel is unremarkable within the confines of CT. No free fluid or peritoneal disease evident. Bilateral tubal ligation clips noted.

Conclusion

  • Biliary obstruction secondary to a 3.2 cm pancreatic head mass lesion most in keeping with adenocarcinoma, which abuts the SMV and the right colic vein but does not encase the vessels (ie less than 180 degrees of vascular contact).
  • Solitary enlarged epiploic foramen lymph node.
  • No evidence of metastatic disease.

Case Discussion

Bx confirmed adenocarcinoma

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Case Information

rID: 40185
Case created: 11th Oct 2015
Last edited: 11th Apr 2016
Inclusion in quiz mode: Included

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