Autoimmune Pancreatitis: Extrapancreatic CT Findings Retroperitoneal Involvement
- Retroperitoneal fibrosis is seen in 10% of cases
Salivary Gland Involvement
- Salivary gland enlargement can be seen in 15% of patients
Pulmonary Involvement
- Reticular nodules or ground glass opacities - Autoimmune Pancreatitis: Extrapancreatic CT Findings
- Renal involvement is seen in about 35% of patients with renal parenchymal involvement in 30% and renal sinus or pelvis in 10% of cases
- Renal parenchymal lesions are often bilateral and multiple and involve the cortex either as discrete lesions or diffuse patchy involvement - Autoimmune Pancreatitis:Extrapancreatic CT Findings
Biliary Involvement in 80% of patients
- Multifocal intrahepatic or extrahepatic duct strictures or thickening with enhancement
- Diffuse thickening of the gallbladder wall
- Soft tissue mass may be seen in port
Renal involvement is seen in about 35% of patients with renal parenchymal involvement in 30% and renal sinus or pelvis in 10% of cases - Autoimmune Pancreatitis: CT Findings
- Diffuse parenchymal enlargement is seen I 40-60% of patients, focal enlargement in 30-40% of patients
- Decreased attenuation during arterial phase and delayed enhancement during late phase imaging
- capsule like rim with halo around gland in 12-40% of cases
- Diffuse or segmental narrowing of the pancreatic duct - Autoimmune Pancreatitis: Facts
- Autoimmune systemic disease witjh elevated IgG4 as a serologic marker
- Involves pancreas and other organ systems including bile ducts, the kidneys, the retroperitoneum, and the salivary glands
- Can simulate pancreatic cancer and is the actual pathology in 2-6% of patients who undergo resection for suspected pancreatic cancer 31-437 "It is important for radiologists to understand both the pancreatic and extrapancreatic imaging findings of autoimmune pancreatitis to make accurate and timely diagnoses." Autoimmune Pancreatitis: Pancreatic and Extrapancreatic Imaging Findings Bodily
KD et al.
AJR 2009; 192:431-437 "Autoimmune pancreatitis is a systemic disease with a wide range of pancreatic and extrapancreatic imaging findings. These findings can mimic those of other diseases in the pancreas or other organs and therefore are commonly misdiagnosed and mistreated. It is important for radiologists to understand both the pancreatic and extrapancreatic imaging findings of autoimmune pancreatitis to make accurate and timely diagnoses." Autoimmune Pancreatitis: Pancreatic and Extrapancreatic Imaging Findings Bodily
KD et al.
AJR 2009; 192:431-437 "In patients with milder interstitial forms of pancreatitis, routine follow-up CT examinations are indicated only in patients with fluid collections to document resolution of fluid or the development of complications." MDCT of Acute Mild (Nonnecrotizing) Pancreatitis: Abdominal Complications and Fate of Fluid Collections
Lenhart DK, Balthazar EJ
AJR 2008; 190:643-649 "A small number of acute, life threatening abdominal complications and chronic complications are expected to occur in patients with milder forms of acute non-necrotizing pancreatitis presenting with fluid collections." MDCT of Acute Mild (Nonnecrotizing) Pancreatitis: Abdominal Complications and Fate of Fluid Collections
Lenhart DK, Balthazar EJ
AJR 2008; 190:643-649 - CT Grading of Pancreatitis(Balthazar Grading System)
Grade | CT Finding | | A | Normal pancreas | | B | Enlarged edematous pancreas | | C | Pancreatic and peripancreatic inflammation (peripancreatic stranding) | | D | Single small peripancreatic fluid collection | | E | Large or several fluid collections or retroperitoneal air |
- Acute Pancreatitis: Classification
Mild acute pancreatitis
- 80% of cases
- No CT evidence of necrosis
- Rapid recovery w/o complications
Severe acute pancreatitis
- 20% of cases
- AKA necrotizing pancreatitis
- CT evidence of necrosis
- Increased incidence of morbidity and mortality
" In the focal form of autoimmune pancreatitis enhancement of the mass was progressive, whereas pancreatic carcinoma was of low attenuation in both the pancreatic and hepatic phases." Autoimmune Pancreatitis:Differentiation From Pancreatic Carcinoma and Normal Pancreas on the Basis of Enhancement Characteristics at Dual-Phase CT
Takahasni N et al.
AJR 2009; 193:479-484 "The pancreas in autoimmune pancreatitis exhibited decreased enhancement in the pancreatic phase with nearly normal enhancement in the hepatic phase of imaging (35 and 60 sec)." Autoimmune Pancreatitis:Differentiation From Pancreatic Carcinoma and Normal Pancreas on the Basis of Enhancement Characteristics at Dual-Phase CT
Takahasni N et al.
AJR 2009; 193:479-484 "At dual phase CT, the enhancement patterns of the pancreas and pancreatic masses inpatients with autoimmune pancreatitis are different from those of pancreatic carcinoma and normal pancreas." Autoimmune Pancreatitis:Differentiation From Pancreatic Carcinoma and Normal Pancreas on the Basis of Enhancement Characteristics at Dual-Phase CT
Takahasni N et al.
AJR 2009; 193:479-484 - Groove Pancreatitis
- Soft tissue within pancreaticoduodenal groove with or without delayed enhancement, small cystic lesions along the medial duodenal wall
- A Clinical and Radiologic Review of Uncommon Types and Causes of Pancreatitis Shanbhogue AK et al. RadioGraphics 2009; 29:1003-1026 - Autoimmune Pancreatitis: CT Findings
- Diffuse glandular enlargement with loss of lobular texture (“featureless gland)
- Homogeneously iso- or hypoattenuating parenchyma with a nondilated or diffusely narrowed pancreatic duct
- “halo” around gland is not uncommon - Autoimmune Pancreatitis can be confused with Pancreatic Cancer
- Hx of weight loss
- No good hx of pancreatitis
- CEA 19-9 may be elevated
- CT appearance often mass like and looks like pancreatic cancer - Autoimmune Pancreatitis: Facts
- Age range 14-77 but most patients over 50
- Male affected 2x compared to woman
- Signs and symptoms at presentation include jaundice (63%), abdominal pain (35%), weight loss (35%), and diabetes mellitus (42-76%)
- Extra-pancreatic processes include sclerosing cholangitis and PBC (68-88%) of cases, IBD (usually ulcerative colitis), Sjogren syndrome, renal involvement, retroperitoneal fibrosis - Autoimmune Pancreatitis
- Type of chronic pancreatitis that is characterized by an autoimmune inflammatory process with lymphoplasmacytic infiltration associated with fibrosis of the pancreas
- Key findings absence of classic hx of prior pancreatitis, elevated immunoglobulin G4, dramatic response to steroid therapy, and difficulty distinguishing from pancreatic cancer - Autoimmune Pancreatitis is also known as
- Lymphoplasmacytic sclerosing pancreatitis
- Chronic sclerosing pancreatitis
- Pseudotumorous pancreatitis
- Nonalcoholic duct destructive chronic pancreatitis - Autoimmune Pancreatitis
- Diffusely enlarged gland with loss of lobular architecture, a "sausage"shape, and a peripheral rind of hypoattenuation; nondilated or diffusely narrowed pancreatic duct,extrapancreatic autoimmune manifestations
- A Clinical and Radiologic Review of Uncommon Types and Causes of Pancreatitis Shanbhogue AK et al. RadioGraphics 2009; 29:1003-1026 - Uncommon Types of Pancreatitis
- Autoimmune pancreatitis
- Groove pancreatitis
- Hereditary pancreatitis
- Pancreatitis in cystic fibrosis
- Pancreatic divisum associated with pancreatitis
- Tropical pancreatitis
- Ascaris induced pancreatitis "Acute pancreatitis is one of the most common conditions for which emergent imaging is indicated. Alcohol consumption and cholelithiasis are the most common causes of acute pancreatitis in adults, whereas the majority of cases in children are idiopathic or secondary to trauma." A Clinical and Radiologic Review of Uncommon Types and Causes of Pancreatitis
Shanbhogue AK et al.
RadioGraphics 2009; 29:1003-1026 - Pancreatic Pseudocysts:Complications
- Infection
- Hemorrhage
- Rupture
- Obstruction of other organs
- Cystic Pancreatic Mass: Differential Diagnosis
- Pseudocyst
- Serous cystadenoma
- Mucinous cystic tumor
- IMPN (intraductal mucinous tumor)
- SPEN (solid and papillary neoplasm)
- Cystic islet cell tumor
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