Pancreatic adenocarcinoma - double duct sign, liver and cystic lung metastases
Presentation
Abdominal discomfort.
Patient Data
Multiple small low-attenuation liver lesions throughout the liver. Dilated gallbladder and bile ducts with the common bile duct tapering in the pancreas head. Pancreas head/uncinate mass with infiltrative margins and upstream atrophy and ductal dilation, small pseudocyst near the tail. Encasement of the confluence and superior mesenteric vein with narrowing, encasement of the superior mesenteric artery. Mildly enlarged regional lymph nodes. Numerous lung nodules at the bases, several of which are cystic with thickened walls.
Case Discussion
This case serves as a good illustration of many features of advanced pancreatic adenocarcinoma, including the typical infiltrative primary tumor resulting in double duct sign and pancreas atrophy, local vascular involvement with venous encasement and narrowing, regional adenopathy, liver metastases, and pulmonary metastases with cystic changes.