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?

6 comments:

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:
http://www.nejm.org/doi/full/10.1056/NEJMra061200

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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