Findings:
A subtle mass effect is seen on the 2nd and 3rd portions of the duodenum on the upper GI series. On CT, a 6 cm mass is seen arising from the uncinate process of the pancreas. Because of it's position below the common bile duct, it was not obstructing the duct (documented on ultrasound) so there was no jaundice and minimal changes in liver enzymes. The pancreas and therefore this mass were obscured on ultrasound because of overlying bowel gas.
Differential:
- Lymphoma
- Focal pancreatitis
- Metastasis
Discussion:
Pancreatic cancer is the 4th leading cause of death in the United States increasing with age over 40. About 1/3 of cases are related to smoking. Most are of unknown cause though a very small number have a hereditary basis.
At the time of diagnosis, only about 20% of pancreatic carcinomas can be removed by surgery and in these cases cure rates are under 50%. In nonresectable cases, median survival is less than one year.
References
Medline Plus
Vascular involvement in pancreatic neoplasm: a comparison between spiral CT and DSA.
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