Hypodense process with ill-defined borders measuring approximately 3.2 x 2.2 x 2.9 cm with a density of 50±5 HU fills the pancreaticoduodenal groove. The process exerts mass effect on both the duodenum and the head of the pancreas and contains small gas bubbles. Mild fat stranding surrounding the second duodenal segment.
The pancreas itself is preserved.
Small sliding hiatal hernia.
Mild hepatic steatosis. Tiny focus of hyperenhancement in segment 2, perhaps flash filling hemangioma.
Gallbladder fundus shows thickened, enhancing wall. No gallstones detected.
Normal-appearing retrocaecal appendix.
Posterior L4-L5 disc herniation, exerting pressure on the thecal sac and narrowing the left neural recess.
In summary
Ill-defined process in pancreaticoduodenal groove containing gas bubbles, with surrounding mild fat stranding. Most compatible with bleeding perforated duodenal ulcer.
Differential diagnosis includes:
- pancreatic adenocarcinoma: mass appears to displace head of pancreas rather than occupy it, no other manifestation of pancreatic carcinoma (pancreas preserved, no dilation of bile ducts or main pancreatic duct, etc.); mass contains bubbles
- groove pancreatitis: no history of pancreatitis; medial duodenal wall is displaced, not thickened, and CBD is not dilated