Presentation
Epigastric pain and jaundice. Suspected pancreatic head mass on ultrasound with extrahepatic biliary obstruction.
Patient Data
A cystic pancreatic lesion is noted showing the following details:
- location: Head
- size: 12.5 x 13.5 cm
- wall (thickness/enhancement): Thin, enhancing
- septa: Innumerable giving a honeycomb or spongiform appearance, more dense near the center forming a scar
- solid nodule: Absent
- calcifications: Scattered, peripheral and septal
- communication with pancreatic duct: Absent
- main pancreatic duct: Dilated (8 mm). no distal atrophy
- background pancreatic parenchyma: Normal
- CBD: Marked intra- and extrahepatic biliary dilatation (CBD = 23 mm)
- related adenopathies: Absent
- vascular encasements: Absents
Non-contrast CT of the abdomen revealed a hypodense mass epicentered on the pancreatic head region with calcifications. It shows smooth wall with no degeneration.
Markedly dilated common bile duct and intrahepatic biliary ducts, likely by the mass effect of the pancreatic head mass compressing the lower CBD end. The pancreatic duct is not dilated.
Multiple bilateral renal simple cortical cysts.
Hyperdense fluid at the pelvicalyceal system bilaterally, likely gadolinium excretion by the kidneys.
Case Discussion
Features are in favor of large pancreatic head serous cystadenoma, with distal common bile duct obstruction and marked biliary ducts dilatation, which is an uncommon feature.
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