CT 101 :Pancreas and Spleen
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1 CT 101 :Pancreas and Spleen Shikha Khullar,, MD, MPH Division of Radiology University of South Alabama
2
3 The Pancreas
4
5 Normal Pancreas
6 3 Phase Pancreatic CT Non contrast Arterial phase : second delay Venous phase : 70 second delay
7 Arterial Phase Portal vein Celiac Portal vein Spleno-portal confluence SMA CBD SMA SMV
8 Venous Phase Portal vein Celiac Portal vein Spleno-portal confluence SMA CBD SMV SMA
9 Non Contrast Portal vein Celiac Portal vein Spleno-portal confluence SMA CBD SMA
10 Diffuse Pancreatic Disease
11 Pancreatic Atrophy
12 Fatty Infiltration
13 Complete Fatty Replacement
14 Benign inflammatory Diseases Acute pancreatitis Chronic pancreatitis
15 Acute Pancreatitis CT may show normal appearing gland Edematous pancreas Stranding in peripancreatic fat, peritoneal planes Irregular decreased attenuation (edema, focal necrosis) Extension of inflammatory process to anterior pararenel space, colon
16 Acute Pancreatitis
17 Pancreatic Necrosis
18 Chronic Pancreatitis Strong association with alcohol abuse CT appearance Irregular dilatation of pancreatic duct Duct width/ Gland width ratio> 0.5, calcifications May present as focal mass
19 Chronic Pancreatitis
20 Focal Pancreatic Disease
21 Focal Pancreatic Abnormality Solid Mass Adenocarcinoma Islet Cell Tumor Others Cystic Mass Pseudocyst Non Pseudocyst IPMT Cystic Neoplasm Serous cystadenoma Mucinous Adenoma Cystic Adenocarcinoma Things that Simulate Masses Focal Pancreatitis Pancreatic Necrosis Pancreatic Laceration
22 Solid Pancreatic Neoplasms Adenocarcinoma Islet cell tumors
23 Adenocarcinoma Majority (65%) occur in head, present early CT findings Hypo-enhancing mass relative to normal parenchyma Dilated common bile duct Dilated pancreatic duct in body and tail Atrophy or pancreatitis distal to mass Convex uncinate process CT useful for staging, determining resectability
24 Adenocarcinoma
25 Adenocarcinoma
26 Adenocarcinoma
27 Adenocarcinoma Encasing SMA
28 Focal Pancreatic Abnormality Solid Mass Adenocarcinoma Islet Cell Tumor Others Cystic Mass Pseudocyst Non Pseudocyst IPMT Cystic Neoplasm Serous cystadenoma Mucinous Adenoma Cystic Adenocarcinoma Things that Simulate Masses Focal Pancreatitis Pancreatic Necrosis Pancreatic Laceration
29 Islet Cell Tumors Uncommon tumors Most common Insulinomas, gastrinomas Differentiating from adenocarcinoma arterial phase hyperenhancement presence of calcification lack of vascular ecasement absence of central necrosis, cystic change
30 Islet Cell Tumor
31 Glucagonoma
32 Islet Cell Tumor
33 Focal Pancreatic Abnormality Solid Mass Adenocarcinoma Islet Cell Tumor Others Cystic Mass Pseudocyst Non Pseudocyst IPMT Cystic Neoplasm Serous cystadenoma Mucinous Adenoma Cystic Adenocarcinoma Things that Simulate Masses Focal Pancreatitis Pancreatic Necrosis Pancreatic Laceration
34 Cystic Masses: A pseudocyst or not a pseudocyst?? Pseudocyst Non Pseudocyst Intraductal papillary mucinous tumor (IPMT) Cystic neoplasms (Serous cystadenoma, mucinous adenomas) Cystic adenocarcinoma
35 Pseudocyst Collection of pancreatic fluid Lacks septations,, mural nodules Result of acute or chronic pancreatitis or pancreatic trauma If managed non-operatively, operatively, will either spontaneously resolve or remain stable
36 Pseudocyst
37 Chronic Pancreatitis with Pseudocyst
38 Focal Pancreatic Abnormality Solid Mass Adenocarcinoma Islet Cell Tumor Others Cystic Mass Pseudocyst Non Pseudocyst IPMT Cystic Neoplasm Serous cystadenoma Mucinous Adenoma Cystic Adenocarcinoma Things that Simulate Masses Focal Pancreatitis Pancreatic Necrosis Pancreatic Laceration
39 Non Pseudocyst : IPMT Communication with pancreatic duct is diagnostic
40 Non Pseudocyst : IPMT
41 Non Pseudocyst : Cystic Neoplasms 10% of cystic pancreatic masses Two groups Microcystic adenoma (serous cystadenoma) Macrocystic adenoma (mucinous( adenoma)
42 Macrocystic Adenoma
43 The Spleen
44 Is the Spleen Normal?
45 Splenomegaly
46 Accessory Spleens 10-20% of population Usually near hilum Same pattern of enhancement as the spleen Same vascular supply
47 Accessory Spleen
48 Multiple Splenules
49 Autosplenectomy
50 Cystic Splenic Mass Posttraumatic pseudocyst - 80% Final stage in evolution of splenic hematoma Congenital epithelial cysts Hydatid cysts Other cystic masses: Pancreatic pseudocyst Lymphangioma, hemangioma Abscess Hematoma
51 Splenic Cyst
52 Multiple Cysts
53 Solid Splenic Masses Lymphoma Splenic involvement in up to 30% patients Several forms: Homogenous enlargement Miliary nodules Multi focal Single solitary mass
54 Other Solid Splenic Tumors Hemangioendothelioma Angiosarcoma Mesenchymal tumors teratoma) Benign Tumors (hemangioma, lymphangioma) Metastasis tumors (fibrosarcoma,leiomyosarcoma,
55 Splenic Metastasis
56 Splenic Infarcts Embolic disease- cardiac or atherosclerotic origin Sickle cell anemia Wedge shaped, base at capsule and apex towards the hilum
57 Splenic Infarct
58 Traumatic Iaceration
59 Take Home Message. Pathology arising from peripancreatic organs (Common Bile Duct, duodenum, lymph nodes) can be confusing Solid Pancreas Mass : Adenocarcinoma does not enhance on arterial phase while Islet cell tumors show hyperenhancement Cystic pancreas mass : Pseudocyst vs Others Pseudocyst lacks internal septations and nodules
60 Acknowledgements Heidi Umphrey, MD Radiology Resident, University of Alabama at Birmingham Janis O Malley, MD Head, Division of Nuclear Medicine, Department of Radiology, UAB HG Liu Research Associate, Division of Nuclear Medicine, Department of Radiology, UAB
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