Presentation
This patient presented with abdominal pain of the upper quadrant and dark urine. Ultrasonic imaging showed a slight dilatation of the common hepatic duct (CHD) of maximum of 8 mm. The ERCP showed a distal carinoma-like CHD-stenosis, a stent was applied. Past history of renal cell carcinoma (RCC) of the right kidney with nephrectomy on 01/2013 pT3b Nx Mx V1 R1. Lung-metastases 05/2014. Start of chemotherapy with Pazopanib from 05/08/2014.
Patient Data
There are at least 5 pancreatic lesions with contrast affinity in the arterial phase in the head, corpus and cauda. Largest is located in the pancreatic head adjacent to the common bile duct. These lesions are isoattenuated to the normal pancreatic parenchyma in the portovenous phase.
A stent is applied in the common bile duct and common hepatic duct. Small air pocket noted in the gallbladder.
Absent right kidney.
Multiple renal cysts of the left kidney, Bosniak I.
Case Discussion
These pancreatic metastases are only seen in the arterial phase. A single phase protocol would have missed these lesions.