Thursday, January 05, 2012

Interesting Imaging (4)

A 60 year-old man with diabetes and hyertension, presented with painless obstructive jaundice. He also has occasional dyspepsia in the past 1 month, and noted weight loss. A MRCP was done, and Radiologist called up and told that there was "interesting finding" (circled).

What is the diagnosis?


lynawan said...

is that colon?

KenophLai said...

Ca tail of pancreas

Darren Lee said...

Thanks for the attempts. I'd say this is a really difficult one, but indeed worth sharing.

What's shown on MR is a diffusely-enlarged pancreas (typically sausage-shaped)with featureless borders and pseudocapsule. This is a classical imaging features suggestive of Autoimmune Pancreatitis (AIP).

AIP is rare and a relatively recently recognized clinical entity, estimated prevalence of 5% of chronic pancreatitis. The most commonly used diagnostic criteria is called HISORT criteria:

1. Diagnostic Histology
2. Characteristic Imaging
3. Serologic testing (elevated serum IgG4)
4. Other organ involvement
5. Response to steroid therapy

Suggested reading:

So you know what to shout out next time when you see such a sausage-shaped pancreas again! ;)

KenophLai said...

I see.. Thanks Dr. Darren!!

Isaac Chan said...

Dr Lee, thanks for that. I have a question, in autoimmune pancreatitis we don't normally see calcification? unlike other chronic pancreatitis?

Darren Lee said...

Isaac: Calcification can be seen in one third of the patients with AIP. A good summary of radiological features of AIP can be found here:

AJR February 2008 vol. 190 no. 2 280-286

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