Infiltrative pancreatic adenocarcinoma - mimicking pancreatitis

Discussion:

Over time as you gain experience in radiology, you will learn to check your assumptions at the door about what age group can get what kind of disease. This bias is especially potent for younger patients, where provides and radiologists alike will reflexively view a tragic cancer diagnosis as the least likely possibility, sometimes resulting in a delayed diagnosis. 

In this case, it is very easy to be lead down the road of acute interstitial pancreatitis due to the patient's young age and findings of mildly dilated pancreas duct, stranding about the head and uncinate process, and lack of substantial intrahepatic biliary ductal dilation. However, running the vasculature is what helps to properly raise high suspicion for cancer. If you look carefully around the proximal SMV and confluence, there is extrinsic soft tissue narrowing the vein (rather than inflammation thrombosing it like in pancreatitis). Also, there is soft tissue wrapping around the SMA, which simply does not make sense in the context of pancreatitis, but is a typical finding of locally advanced pancreas adenocarcinoma. 

In summary, be sure to consider the possibility of adenocarcinoma or other primary pancreas tumors when first evaluating a suspected case of pancreatitis. 

This patient went to endoscopic biopsy which unfortunately confirmed the diagnosis of adenocarcinoma. 

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