Presentation
Abdominal pain. Elevated ESR, CRP, and CA19-9.
Patient Data
A 40 mm ill-defined low-enhancing mass is seen in the pancreatic head, neck and proximal of the body, causing distal pancreatic atrophy and duct dilatation. The mass encases the common hepatic artery, SMV and portal confluence, and abuts the proximal of the splenic artery. Intra and extra-hepatic bile ducts are dilated, and the distal part of CBD is infiltered by the mass.
A few prominent lymph nodes with SAD less than 7 mm are seen in the vicinity of the mass.
In addition, several small ill-defined low-enhancing masses are seen in the liver less than 18 mm, suspected for metastases.
Several non-enhanced simple cortical cysts are seen in both kidneys.
Sliding hiatal hernia is seen.
Case Discussion
Pathology-proven pancreatic ductal adenocarcinoma with vascular encasement and abutment, small regional lymphadenopathy, and hepatic metastasis.
The primary factors indicating that pancreatic ductal adenocarcinoma is unresectable are the existence of metastasis and/or invasion of blood vessels, specifically encasement of the celiac trunk and superior mesenteric artery. A comprehensive report ought to incorporate these essential discoveries.
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