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Metastatic Pancreatic Adenocarcinoma

Shogan PJS - MedPix (2008)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Metastatic Pancreatic Adenocarcinoma

History: 52 yo male with RUQ pain and abnormal liver associated enzymes.

Findings: Contrast enhanced images through the liver, obtained during the hepatic arterial phase and viewed with liver windows, shows multiple nodular hypodensities throughout the liver parenchyma, with surrounding peripheral rim enhancement and associated wedge-shaped high-attenuation areas. Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas.

Ddx: Differential Diagnosis for Transient Hepatic Attenuation Difference (THAD): Hepatocellular carcinoma is the most common primary hepatic tumor associated with THAD. In regards to cholangiocarcinoma, THAD is an important indirect sign of vascular invasion. Metastatic hypervascular lesions from islet cell tumors, carcinoids, renal cell carcinoma, and breast carcinoma may also have this imaging appearance. Hemangiomas, focal nodular hyperplasia, pyogenic abscess, and focal eosinophilic necrosis are additional differential considerations. Finally, hepatic hemodynamic alterations caused by liver cirrhosis, portal or hepatic vein thrombosis, and arterioportal shunts may result in THAD.

Dxhow: Biopsy confirmed pancreatic adenocarcinoma.

Exam: AST: 52 (H) U/L ALT: 49 (30-65) U/L APhos: 236 (H) U/L TBili: 0.7 mg/dL DBili: 0.1 mg/dL

No MeSH data available.


Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas.  Biopsy confirmed pancreatic adenocarcinoma.
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MPX1556_synpic45721: Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas. Biopsy confirmed pancreatic adenocarcinoma.


Metastatic Pancreatic Adenocarcinoma

Shogan PJS - MedPix (2008)

Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas.  Biopsy confirmed pancreatic adenocarcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1556&req=5

MPX1556_synpic45721: Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas. Biopsy confirmed pancreatic adenocarcinoma.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Metastatic Pancreatic Adenocarcinoma

History: 52 yo male with RUQ pain and abnormal liver associated enzymes.

Findings: Contrast enhanced images through the liver, obtained during the hepatic arterial phase and viewed with liver windows, shows multiple nodular hypodensities throughout the liver parenchyma, with surrounding peripheral rim enhancement and associated wedge-shaped high-attenuation areas. Contrast enhanced image through the pancreas shows a hypodense mass in the body. Note the attenuation difference between the tumor and the avidly enhancing normal pancreas.

Ddx: Differential Diagnosis for Transient Hepatic Attenuation Difference (THAD): Hepatocellular carcinoma is the most common primary hepatic tumor associated with THAD. In regards to cholangiocarcinoma, THAD is an important indirect sign of vascular invasion. Metastatic hypervascular lesions from islet cell tumors, carcinoids, renal cell carcinoma, and breast carcinoma may also have this imaging appearance. Hemangiomas, focal nodular hyperplasia, pyogenic abscess, and focal eosinophilic necrosis are additional differential considerations. Finally, hepatic hemodynamic alterations caused by liver cirrhosis, portal or hepatic vein thrombosis, and arterioportal shunts may result in THAD.

Dxhow: Biopsy confirmed pancreatic adenocarcinoma.

Exam: AST: 52 (H) U/L ALT: 49 (30-65) U/L APhos: 236 (H) U/L TBili: 0.7 mg/dL DBili: 0.1 mg/dL

No MeSH data available.