Presentation
Severe right flank pain and history of renal colic.
Patient Data
A 42 mm ill-defined low-enhancing mass is seen in the pancreatic neck and proximal of the body that causes distal duct dilatation and parenchymal atrophic changes. The mass encases the celiac trunk, proximal of hepatic and splenic arteries, and portal and splenic veins.
Multiple dilated collateral vessels are seen in the upper abdomen.
Several regional enlarged lymph nodes are seen.
In addition, multiple low-enhancing masses are seen in the liver less than 60 mm, inferring metastasis.
Moderate hydronephrosis is seen on the right side due to a 13 mm mid-ureteral stone. A few small stones less than 5 mm are also seen in the lower calyces of the right kidney.
Case Discussion
Pathology-proven pancreatic ductal adenocarcinoma with vascular encasement, regional enlarged lymph nodes, and hepatic metastasis.
The main criteria for the unresectability of pancreatic ductal adenocarcinoma are the presence of metastasis and/or vascular invasion, particularly encasement of the celiac trunk and superior mesenteric artery. A structured report should include these two critical findings.