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Gastrointestinal Imaging (Beri) > Pancreas (for PBR 2) > Flashcards

Pancreas (for PBR 2) Flashcards

1
Q

Two morphologic types of pancreatitis

A

Interstitial edematous

Acute necrotizing pancreatitis

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2
Q

Imaging finding of interstitial edematous pancreatitis

A

CE CT:

Localized or diffuse enlargement of the pancreas with normal homogeneous parenchymal

Slightly heterogeneous enhancement due to edema

Mild fat stranding and peripancreatic inflammatory changes may be present with varying fluid volumes of peripancreatic fluid

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3
Q

Acute necrotizing pancreatitis is divided into three forms by CT appearance

A
  1. Pancreatic parenchymal necrosis with peripancreatic necrosis
  2. Peripancreatic necrosis alone
  3. Pancreatic parenchymal necrosis alone
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4
Q

Most common form of acute necrotizing pancreatitis

A

Pancreatic parenchymal necrosis with peripancreatic necrosis

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5
Q

Imaging finding of pancreatic parenchymal necrosis with peripancreatic necrosis

A

Lack of parenchymal enhancement associated with nonliquefied heterogeneous areas of nonenhancement in peripancreatic tissues, most commonly in the lesser sac and retroperitoneum

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6
Q

Pancreatic necrosis is best determined by CT at approximately how many hours following onset of symptoms?

A

72 hours

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7
Q

Collections associated with interstitial pancreatitis

Initial 4 weeks as nonencapsulated, nonenhancing, low attenuation, liquid collections without solid components

Walls are imperceptible

A

Acute peripancreatic fluid collections

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8
Q

These are defined as simple collections with perceptible walls seen after 4 weeks

A

Pseudocyst

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9
Q

Collections associated with necrotizing pancreatitis seen in the first 4 weeks

A

Acute necrotizing collections

Heterogeneous collections containing hemorrhage, fat, or necrotic fat within or surrounding necrotic pancreatic parenchyma

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10
Q

An enhancing wall may develop around an acute necrotic collection and seen after 4 weeks -

What is the term of the collection?

A

Walled-off necrosis

WONs appear heterogeneous in attenuation and complex because of variable necrotic tissues and debris

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11
Q

This is caused by recurrent and prolonged bouts of acute pancreatitis that cause parenchymal atrophy and progressive fibrosis

A

Chronic pancreatitis

Both exocrine and endocrine function of the pancreas may be impaired

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12
Q

Most common cause of chronic pancreatitis

A

Alcohol abuse (70%)

Biliary stone disease (20%)

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13
Q

Morphologic changes and imaging findings of chronic pancreatitis

A
  1. Dilation of the pancreatic duct (usually in a beaded pattern of alternating areas of dilation and constriction)
  2. Decrease in visible pancreatic tissue because of atrophy
  3. Calcifications (finely stippled to coarse)
  4. Focal-mass-like enlargement of the pancreas (owing to benign inflammation and fibrosis)
  5. Stricture of the bile duct (because of fibrosis or mass in the pancreatic head resulting in proximal bile duct dilation)
  6. Fascial thickening and chronic inflammatory changes in surrounding tissues
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14
Q

Also known as lymphoplasmacytic sclerosing pancreatitis

Unique form of pancreatitis caused by autoimmune disease associated with elevation of IgG4

A

Autoimmune pancreatitis

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15
Q

Extrapancreatic manifestations of autoimmune pancreatitis

A

Inflammatory bowel disease (ulcerative colitis)
Long segment bile duct strictures
Lung nodules
Lymphadenopathy
Lymphocytic infiltrates in the liver and kidneys
Retroperitoneal fibrosis
Sjogren syndrome

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16
Q

Findings that favor diagnosis of autoimmune pancreatitis over adenocarcinoma

A
  1. Diffuse or focal swelling of the pancreas with characteristic halo of edema
  2. Extensive peripancreatic stranding and edema are absent
  3. Diffuse or segmental narrowing of the pancreatic duct and/or the common bile duct
  4. Absence of dilation of the pancreatic duct and absence of parenchymal atrophy proximal to the pancreatic mass (theses findings are typically present with adenocarcinima)
  5. Fluid collections and parenchymal calcifications are typically absent
  6. Peripancreatic blood vessels are usually not involved
  7. Kidneys are involved in 1/3 of cases (round-wedge-like , or diffuse peripheral patchy areas of decreased contrast enhancement)
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17
Q

This is an uncommon form of pancreatitis that may also mimic adenocarcinoma

Fibrosis in the groove between the head of the pancreas, the descending duodenum, and the common bile duct produces an inflammatory mass that obstructs the common bile duct

A

Groove pancreatitis

18
Q

Characteristic finding of groove pancreatitis

A
  1. Sheet-like mass in the pancreaticoduodenal groove
  2. Atrophy and fibrotic changes in the pancreatic head
  3. Small cysts along the wall of the duodenum
  4. Duodenal wall thickening and luminal narrowing
  5. Tapering stenosis of the common bile and pancreatic ducts
  6. Widening of the space between the distal ducts and the wall of the duodenum (rarely seen with adenocarcinoma)
  7. Enhancement is delayed but progressive
19
Q

Signs of resectability of pancreatic adenocarcinoma

A
  1. Isolated pancreatic mass with or without dilation of the bile or pancreatic ducts
  2. No extrapancreatic disease
  3. No encasement of celiac axis or SMA
20
Q

Signs of potential resectability

A
  1. Absence of involvement of the celiac axis or SMA
  2. Occlusion of the superior mesenteric or portal vein without a technical option for reconstruction
  3. Liver, peritoneal, lung, or any other distant metastases
21
Q

Evidence of arterial encasement that indicates unresectability

A
  1. Tumor abutting >180 degrees of the circumference of the artery
  2. Tumor abutment focally narrowing the artery
  3. Occlusion of the artery by tumor
22
Q

These tumors may be functioning producing hormones resulting in distinct clinical syndromes, or may be nonfunctional and grow to large size before presenting clinically

A

Neuroendocrine (islet cell) tumors

23
Q

Different types of neuroendocrine (islet cell) tumors

A 
Insulinomas
Gastrinomas
Glucagonoma
Somatostatinoma
VIPoma
24
Q

80% of nonfunctioning tumors are:

a. benign
b. malignant

A

Malignant

25
Q

Imaging findings of nonfunctioning neuroendocrine tumors

A 
Coarse calcifications
Cystic degeneration
Necrosis
Local and vascular invasion
Metastases
26
Q

CT scan finding of lymphoma

A

Homogeneous, of lower attenuation than muscle, and show limited enhancement

Lesions can be localized, well-defined mass, or be infiltrating diffusely enlarging or replacing gland

Attenuation may be so lows as to appear cystic

27
Q

Types of fatty lesions of the pancreas

A

Diffuse fatty infiltration (associated with aging and obesity and is seen with pancreatic atrophy)

Focal fatty infiltration (between the lobules of pancreatic parenchyma)

Focal fatty sparing (in diffuse infiltration may simulate a pancreatic mass, especially when it involves the head or uncinate process

Lipoma

28
Q

Most common pancreatic cystic lesions

A

Pancreatitis-associated fluid collections

29
Q

Findings of pancreatitis-associated fluid collections

A
  1. Fluid-density unilocular cyst
    (associated with findings of acute or chronic pancreatitis)
  2. Complex cystic mass
    (with internal hemorrhage, infection, or gas)
  3. Most are round or oval with a thin or thick wall that may enhance
    (however, cyst contents do not enhance)
  4. Septations and lobulated contours (unusual and more often associated with serous cystadenoma)
  5. Some lesions may be infected showing the presence of gas and debris within the lesion
  6. Serial imaging usually shows involution of noninfected collections
30
Q

What are the three major appearances of serous cystadenomas

A
  1. Honeycomb microcyst (microcystic adenoma) with innumerable cysts 1 mm to 2 cm size - MOST COMMON
  2. Macroscropic form with larger cysts
  3. Innumberable tiny cysts

Lesions do not communicate with the pancreatic duct

31
Q

Classification of cystic mucinous neoplasms of the pancreas

A

Papillary mucinous neoplasm

Mucinous cystic neoplasm

32
Q

In cystic mucinous neoplasms:

“Worrisome features”

A
  1. Cysts >3 cm diameter
  2. Enhancing thickened cyst walls
  3. Main pancreatic duct diameter 5 to 9 mm
  4. Mural nodules without enhancement
  5. Abrupt narrowing of main pancreatic duct w/ proximal atrophy of pancreatic parenchyma
  6. Regional lymphadenopathy
33
Q

In cystic mucinous neoplasms:

“High-risk stigmata”

A
  1. CBD obstruction w/ jaundice associated w/ cystic tumor in pancreatic head
  2. Enhancement of solid components
  3. Main pancreatic duct >10 mm
34
Q

Intraductal papillary mucinous neoplasms are classified into 3 morphologic types

A 
Branch duct (BD-IPMN)
Main duct (MD-IPMN)
Mixed type
35
Q

Type of IPMN :
Most common in the uncinate process arising in branches of the main pancreatic duct to form grape-like collections of small cysts (5- to 20-mm diameter) that communicate with the ductal system

A

Branch duct - IPMN

Some lesions consist of a single unilocular cyst

Cyst have thin walls w/ flat or papillary lining that produces tenacious mucin

Invasive carcinoma - 17%

36
Q

Type of IPMN :
This is characterized by diffuse or segmental dilation of the main pancreatic duct >5-mm diameter without evidence of other causes of obstruction

A

Main duct - IPMN

Diffusely or partially dilated, tortuous and irregular, main pancreatic duct is filled with mucin produced by tumor cells

37
Q

Presence of ovarian stroma in addition to mucin-producing epithelial tumor cells is specific to this pancreatic tumor

Occurs nearly always in women

Do not arise from or communicate with the pancreatic duct

A

Mucinous cystic neoplasm

38
Q

Imaging finding of mucinous cystic neoplasm

A
  1. Cystic lesion larger than 2 cm nearly always in the pancreatic tail
  2. Tumors are multilocular with a few compartments or uncommonly unilocular
  3. Papillary projections of solid tumor are common
  4. Peripheral eggshell calcification - uncommon but highly specific finding
39
Q

This is a rare low-grade pancreatic malignancy that presents as a large encapsulated mass with a mixture of fluid, hemorrhagic, necrotic, and solid components

It is not truly papillary or cystic

A

Solid pseudopapillary tumor

Pseudopapillae are formed by layers of epithelial cells that cover a fibrovascular core

40
Q

Imaging finding of a solid pseudopapillary tumor

A

CT shows a heterogeneous well-encapsulated tumor with variable cystic and solid components

Solid areas, usually in the periphery, enhance

Peripheral calcifications may be present

41
Q

Cystic change in neuroendocrine tumors are a result of what process?

A

Tumor degeneration

42
Q

Cystic change in adenocarcinoma is the result of what process?

A

Necrosis, hemorrhage, or formation of pseudocysts adjacent to the neoplasm

Gastrointestinal Imaging (Beri) (26 decks)

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