Study of role of computerized tomography (CT) in evaluation of groove pancreatitis

2021 ◽  
Vol 20 (1) ◽  
pp. 15-19
Author(s):  
Swadeep Raj G ◽  
Keyword(s):  
Pancreatic Head ◽  
Final Diagnosis ◽  
Duodenal Wall ◽  
Wall Thickening ◽  
Imaging Findings ◽  
Pure Type ◽  
Groove Pancreatitis ◽  
Hyperintense Signal ◽  
Contrast Enhanced Ct ◽  
Pancreatic Duct Dilatation

Background: Groove pancreatitis is a rare form of chronic pancreatitis affecting the groove between the pancreatic head, duodenum and common bile duct. The exact cause of the disease is not known, although there are strong associations with long term alcohol abuse, functional obstruction of duct of Santorini and brunner gland hyperplasia. The purpose of this study was to describe the imaging findings of groove pancreatitis (GP) on Contrast enhanced CT Abdomen. Material and Methods: Present study was retrospective study conducted, with help of medical records of 16 patients with a final diagnosis of Groove pancreatitis. CT, MRI and MRCP findings were analysed. Statistical analysis was done using descriptive statistics. Results: In present study, two types of groove pancreatitis (GP) as pure type (50%) and segmental type (50%) were noted. Other important findings were focal duodenal wall thickening (62.5%) and cysts in the duodenal wall itself or in groove between the pancreatic head and the duodenum (37.5%), CBD dilatation and distal smooth tapering (62.5%) including all the segmental types and 2 of the pure type leading to intra- and extra-hepatic biliary system dilatation. MRI and MRCP were available in 6 patients in our study. There was a CT similarity regarding the sheet of tissues within the pancreaticoduodenal groove. These were seen expressing T1 hypo-intense and T2 slightly hyperintense signal in 3 patients with depiction of mild enhancement in the delayed phases in three of them (50%). On the MDCT examinations hypodense sheet at the PD groove was seen in 12 patients with modest enhancement identified in delayed phase seen in 6 of the them. Duodenal wall thickening was seen in 10 patients while associated cysts within the duodenal wall or in PD groove were seen in 6 patients. Pancreatic head enlargement with diffuse enhancement was seen in 8 patients. Mild pancreatic duct dilatation was seen in 8 patients while dilatation of the CBD was seen in 10 patients with distal tapering and intra-hepatic biliary dilatation. Conclusion: Groove pancreatitis (GP) is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall.

GROOVE PANCREATITIS -A DIAGNOSTIC DILEMMA

2021 ◽  
pp. 55-56
Author(s):  
Aleena Elizabeth Andrews
Keyword(s):  
Surgical Intervention ◽  
Soft Tissue Mass ◽  
Pancreatic Head ◽  
Duodenal Wall ◽  
Diagnostic Dilemma ◽  
Tissue Mass ◽  
Groove Pancreatitis ◽  
Cystic Changes ◽  
The Common ◽  
Anatomical Area

Groove pancreatitis is a segmental chronic pancreatitis that affects the groove area, classically the anatomical area between the pancreatic head, the duodenum, and the common bile duct. The etiopathogenesis remains elusive till date, though association with alcohol abuse has been described in literature. Imaging feature described include soft tissue mass in the groove, thickening of medial wall of duodenum, thus closely mimicking a neoplastic aetiology and hence posing diagnostic dilemma. However classic ndings of cystic changes in the groove extending to duodenal wall and brotic component can aid the radiologist in making an accurate diagnosis and thus avoiding unnecessary surgical intervention. Groove pancreatitis is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall.

scholarly journals Hypervascular pancreatic metastasis: an easy imaging diagnostic?

2020 ◽  
Vol 3 (1) ◽  
pp. 18-21
Author(s):  
Ioana G. Lupescu ◽  
Mirela Boroş ◽  
Florinela Ștefănescu
Keyword(s):  
Final Diagnosis ◽  
Pancreatic Metastasis ◽  
Arterial Phase ◽  
Uterine Leiomyosarcoma ◽  
Diagnostic Challenge ◽  
Pancreatic Metastases ◽  
Hyperintense Signal ◽  
Contrast Enhanced Ct ◽  
Mri Features ◽  
Enhanced Ct

Learning objectives. To review the computed tomograpy (CT) and magnetic resonance imaging (MRI) features of hypervascular pancreatic metastases (HPM). To discuss the main differential diagnosis of HPM. Materials and method. We retrospectively analyzed images from the CT and MRI evaluations of six patients who were diagnosed with HPM by morphopathological examination in the last ten years. Results. In our study, hypervascular pancreatic metastases corresponded to renal cell carcinoma, breast carcinoma and uterine leiomyosarcoma. In non-enhanced CT (NECT), all lesions were isodense or slightly hypodense. After i.v. injection of contrast medium (CM), hypervascular pancreatic metastases have displayed an early arterial phase enhancement, followed by rapid washout in the portal and delayed phases images. Contrast-enhanced CT showed for pancreatic metastases from uterine leio­myo­sarcoma a gradual enhancement. The common ap­pea­rance in MRI for HPM was hypointense in T1 weighted image (wi), heterogeneous aspect in T2 wi or mo­de­ra­tely hyperintense signal with restricted diffusion. After Gd-based CM i.v. injection, HPM showed the same dy­namic as in CT evaluation. Conclusions. HPM may create a diagnostic challenge, therefore the pathological exa­mi­na­tion remains essential and represents the gold standard for the final diagnosis.

scholarly journals Pancreas-preserving duodenal resections as a surgery of choice for the isolated form of cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)

2019 ◽  
Vol 47 (6) ◽  
pp. 477-495
Author(s):  
V. I. Egorov ◽  
R. V. Petrov ◽  
A. I. Schegolev ◽  
E. A. Dubova ◽  
A. N. Vankovich ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Whipple Procedure ◽  
Pure Form ◽  
Long Term Results ◽  
Treatment Modalities ◽  
Duodenal Wall ◽  
Exocrine Insufficiency ◽  
Results Of Treatment ◽  
Groove Pancreatitis ◽  
Diagnostic Modalities

Background: Management of the isolated form of cystic dystrophy of the duodenal wall (CDDW), or pure form of groove pancreatitis, is controversial. Pancreatoduodenectomy is considered to be the most suitable procedure for CDDW. Pancreas-preserving procedures (PPDR) have been described as surgical options for the cases where only the duodenum has been involved. There are no studies comparing pancreas-preserving vs. pancreas-resecting procedures for this disease.Aim: To analyze the results and outcomes of PPDR and other treatment approaches to CDDW and to review the literature.Materials and methods: We performed a retrospective analysis of 82 patients with CDDW who received treatment from February 2004 to April 2019. We compared short-term and long-term results of treatment of 15 patients with isolated CDDW after PPDR and 42 patients with CDDW after pancreatoduodenectomy.Results: The preoperative diagnosis was correct in 81 of the cases (98.8%). The patients experienced abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Twelve patients with CDDW took conservative treatment due to rejection of the operation. The other patients underwent cystoenterostomies (8), duodenum-preserving pancreatic head (DPPH) resections (6), pancreatoduodenectomy (42) and PPDR (15) with zero mortality. Full pain control was achieved after PPDR in 93%, after pancreatoduodenectomy in 83%, and after draining procedures in 18% of the cases. Newly onset diabetes mellitus (7) and severe exocrine insufficiency (5) were common after pancreatoduodenectomy and never occurred after DPPH resections and PPDR. Weight gain was significantly higher after pancreatoduodenectomy and PPDR, compared to other treatment modalities.Conclusion: PPDR is the optimal surgical procedure for the isolated form of CDDW. Early detection of CDDW allows for preservation of the pancreas. The pure form of groove pancreatitis is a disease of the duodenum, and the Whipple procedure should be considered excessive for this disease.

Early, late or no surgery for the groove pancreatitis? experience of 86 cases of the cystic dystrophy of the duodenal wall

Pancreatology ◽  
2021 ◽  
Vol 21 ◽  
pp. S37-S38
Author(s):  
V. Egorov ◽  
R. Petrov ◽  
A. Schegolev ◽  
E. Dubova ◽  
A. Vankovich ◽  
...  
Keyword(s):  
Duodenal Wall ◽  
Groove Pancreatitis ◽  
Early Late

Imaging Findings in a Case of Carcinoma Oesophagus Presenting with an Intra-Atrial Mass on Echocardiography

2021 ◽  
Vol 8 (25) ◽  
pp. 2238-2241
Author(s):  
Dhruba Borpatra Gohain ◽  
Sujan Dibragede ◽  
Amrita Das ◽  
Tanaya Sarma
Keyword(s):  
Pericardial Effusion ◽  
Left Atrium ◽  
Histopathological Examination ◽  
Normal Sinus Rhythm ◽  
Tertiary Care ◽  
Chest Roentgenogram ◽  
Wall Thickening ◽  
Imaging Findings ◽  
Pulmonary Vessels ◽  
Atrial Mass

A 53-year-old male presented to our tertiary care center with complaints of palpitation and difficulty in breathing on exertion which was insidious in onset and gradually progressive. He had a history of back ache and significant weight loss. His physical examination and initial laboratory work up revealed no obvious abnormality. His initial radiological investigation involved chest roentgenogram which revealed cardiomegaly with mediastinal widening and haziness in left lower lung zone (Figure 1). His (electrocardiogram) ECG revealed normal sinus rhythm. Later, patient underwent echocardiography which revealed normal systolic flow with a mass extending up to pericardium (measuring 6.9 x 4.1 cm) in left atrium obstructing mitral flow and minimal pericardial effusion. He was sent to our department for contrast enhanced computerised tomography (CT) thorax scan to evaluate the extension of the left intra atrial mass which revealed a heterogeneously enhancing circumferential wall thickening in mid oesophagus extending from T7 - T11 for an approximate length of 8.3 cm with a single wall thickness of 2.3 cm in left lateral wall. There was also a heterogeneously enhancing lobulated soft tissue density mass with hypodense area within measuring 6.4 (CC) x 7.3 (AP) x 7.9 (TR) cm in left paraesophageal region infiltrating into adjacent pulmonary vessels and left atrium forming a large intracavitary mass with collapse of adjacent lung parenchyma and pericardial effusion with a maximum depth of 1.7 cm (Figure 2 & 3). Multiple enlarged lymph nodes were noted in paratracheal, pretracheal precranial and perivascular regions, largest measuring 1.2 cm in SAD in paratracheal regions (Figure 2B). Based on the imaging findings we made the diagnosis of malignant oesophageal growth with metastatic paraesophageal nodal mass infiltrating into adjacent pulmonary vessels and left atrium forming a large intra-cavitary mass. On following up, endoscopic workup revealed a nodular growth in oesophagus extending from 33 to 38 cms with intact overlying mucosa (Figure 4). On histopathological examination of the specimen taken from the oesophageal growth revealed to be squamous cell carcinoma infiltrating to muscle coat.

scholarly journals Spontaneous Resolution of Hemorrhagic Pseudocyst-Associated Pseudoaneurysm in Groove Pancreatitis

2020 ◽  
Vol 14 (1) ◽  
pp. 131-136
Author(s):  
Gwang Mo Kim ◽  
Soon Young Ko ◽  
Joon Ho Wang
Keyword(s):  
Pancreatic Duct ◽  
Clinical Presentation ◽  
Healing Process ◽  
Stable Condition ◽  
Pancreatic Head ◽  
Stent Insertion ◽  
First Line ◽  
Groove Pancreatitis ◽  
Pancreatic Sphincterotomy

Hemorrhagic pseudocyst (HP) and pseudocyst-associated pseudoaneurysms (PPs) are complications of pseudocyst. Angiography with embolization has been advocated as the first-line intervention for HP. A 47-year-old man with groove pancreatitis combined with HP near the pancreatic head was treated conservatively. He had relapsed pancreatitis with a newly identified pseudoaneurysm; however, the pseudocyst size was reduced. Although pseudoaneurysm was identified, angiography was not performed because there was no evidence of ongoing bleeding, and he was in a stable condition. Sphincterotomy and stent insertion in the pancreatic duct was applied to prevent relapsed pancreatitis with facilitation of the flow of pancreatic juice. He has done well during the 10-month follow-up, without recurrent pancreatitis. Angiography as an initial approach in HP and PPs may need to be more selective depending on the clinical presentation of the patient. A lysed clot within the strictured pancreatic duct during the healing process has been thought to be the cause of relapsed pancreatitis, and pancreatic sphincterotomy and stent insertion should be the preferred treatment methods.

Lymphangioma of the pancreas and the duodenal wall: MR imaging findings

2001 ◽  
Vol 11 (11) ◽  
pp. 2232-2235 ◽  
Author(s):  
G. Schneider ◽  
R. Seidel ◽  
K. Altmeyer ◽  
K. Remberger ◽  
G. Pistorius ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Duodenal Wall ◽  
Imaging Findings

Small cell carcinoma of gall bladder: An uncommon histologic entity

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
Amit Gupta ◽  
ROHIK ANJUM ◽  
Rishit Mani ◽  
Navin Kumar ◽  
Anoushika Mehan ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Pancreatic Head ◽  
Small Cell ◽  
The Body ◽  
Wall Thickening ◽  
Main Portal Vein ◽  
Significant Weight Loss ◽  
Upper Abdomen

Gall bladder small cell carcinoma (scc) comprises of 0.5% of all GB cancers. It carries a poor prognosis in view of its aggressive nature. We here report a case of small cell carcinoma GB 55-year old lady presented with features of obstructive jaundice with significant weight loss. Examination revealed hard lump in right upper abdomen with multiple scratch marks all over the body. Clinically she had jaundice. Blood investigations revealed hyperbilirubinemia. Tumour markers showed raised CA 19-9. Staging CECT thorax and Abdomen reported polypoidal enhancing wall thickening of gall bladder with multiple metastatic deposits close to pancreatic head encasing main portal vein and common bile duct. Histopathology was suggestive of small cell carcinoma. Patient was referred to Oncology department and is receiving palliative cisplatin-etoposide chemotherapy

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