Imaging Pearls ❯ Pancreas ❯ Groove Pancreatitis
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- ”Paraduodenal pancreatitis (PDP) is a rare form of chronic pancreatitis that affects the space between the duodenal “C” loop and the head of the pancreas known as the pancreaticoduodenal groove. Two forms of PDP have been described—the pure form which involves the groove only and the segmental form which involves the groove and extends to the pancreatic head. The actual incidence of PDP is unknown, however an incidence of 2.7%, 19.5%, and 24.4% have been reported in three separate surgical series of patients undergoing pancreaticoduodenectomies.”
Inflammatory mimickers of pancreatic adenocarcinoma
Kunal Kothar ET AL.
Abdominal Radiology (In Press, 2019) https://doi.org/10.1007/s00261-019-02233-7 - “The typical patient affected with PDP is a middle- aged male (40–50 years of age) with a history of significant alcohol abuse which can be more suggestive of the diagnosis. MDCT findings vary between the pure and segmental forms. The pure form may appear as ill-defined fat stranding/inflammatory changes in the pancreaticoduodenal groove or as a soft tissue in the pancreaticoduodenal groove often with a “sheetlike” curvilinear crescentic appearance that is best appreciated on coronal multiplanar reformatted images. Thickening of the medial duodenal wall may be seen, especially on the coronal images. The segmental form can be more difficult to observe because involvement of the groove is often concealed by mass-like enlargement of the pancreatic head.”
Inflammatory mimickers of pancreatic adenocarcinoma
Kunal Kothar ET AL.
Abdominal Radiology (In Press, 2019) https://doi.org/10.1007/s00261-019-02233-7 - ”Inflammatory pancreatic processes can make it difficult for the radiologist to discover an underlying PDA. It is important for radiologists to assess for subtle clues to distinguish these processes from PDA. In the setting of an older patient without risk factors for pancreatitis, findings such as focal pancreatitis duct dilatation with abrupt duct cut-off may signal an underlying PDA. Mass-forming inflammatory conditions such as chronic pancreatitis can be confused with PDA, however supplementary findings, such as a smoothly stenotic pancreatic duct penetrating through the mass (duct-penetrating sign), can help favor a mass-forming inflammatory condition.”
Inflammatory mimickers of pancreatic adenocarcinoma
Kunal Kothar ET AL.
Abdominal Radiology (In Press, 2019) https://doi.org/10.1007/s00261-019-02233-7
- “Groove pancreatitis is a rare focal form of chronic pancreatitis that occurs in the pancreaticoduodenal groove between the major and minor papillae, duodenum and pancreatic head. Radiologic appearance and clinical presentation can result in suspicion of malignancy rendering pancreaticoduodenectomy inevitable.”
Dual-phase CT findings of groove pancreatitis Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation. The main pancreatic duct was dilated in 7 patients, with an abrupt cut off in 3 and a smooth tapering stricture in 4. Five patients had evidence of chronic pancreatitis with parenchymal calcifications.”
Dual-phase CT findings of groove pancreatitis Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation.”
Dual-phase CT findings of groove pancreatitis Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “In conclusion, the diagnosis of GP may be difficult on MDCT and exclusion of malignancy such as pancreatic adenocarcinoma, ampullary and duodenal carcinomas is important. However, certain features seen on MDCT such as sheet like hypodensity in the PD groove, medial duodenal wall thickening and cystic changes in the duodenal wall along with evidence of chronic pancreatitis in the pancreatic head are highly suggestive of GP.”
Dual-phase CT findings of groove pancreatitis Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “Presence of mass or soft tissue thickening in the groove with cystic duodenal thickening is highly suggestive of groove pancreatitis. Recognizing common radiological features may help in diagnosis and reduce suspicion of malignancy.”
Dual-phase CT findings of groove pancreatitis Atif Zaheer, Maera Haider, Satomi Kawamoto, Ralph H. Hruban, Elliot K. Fishman Eur J Radiol. 2014 Aug; 83(8): 1337–1343.
- “Groove pancreatitis (GP, also known as paraampullary duodenal wall cyst) is an uncommon but distinctive form of segmental chronic pancreatitis affecting the pancreaticoduodenal (PD) groove region between the head of the pancreas, the duodenum and the major and minor papillae.”
Dual-phase CT findings of groove pancreatitis Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “The most characteristic finding on CT was the presence of a hypodensity located in the PD groove resulting in the widening of the distance between the pancreas and the duodenum. This area appeared hypodense on both phases and the appearance ranged from a mass like area to peripancreatic stranding around the head. This abnormality, previously been described as an area of “sheet-like” curvilinear and crescentic morphology representing chronic inflammatory and fibrotic changes, was seen in all patients.”
Dual-phase CT findings of groove pancreatitis Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “The other common finding on CT was the presence of duodenal involvement characterized by eccentric wall thickening involving the medial duodenal wall leading to luminal narrowing, and the presence of cysts in the duodenal wall. A high incidence of these finding have been previously described in patients with GP.”
Dual-phase CT findings of groove pancreatitis Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “In conclusion, the diagnosis of GP may be difficult on MDCT and exclusion of malignancy such as pancreatic adenocarcinoma, ampullary and duodenal carcinomas is important. However, certain features seen on MDCT such as sheet like hypodensity in the PD groove, medial duodenal wall thickening and cystic changes in the duodenal wall along with evidence of chronic pancreatitis in the pancreatic head are highly suggestive of GP. Although, a significant number of these patients may require definitive surgery for symptom relief, recognition of these findings may be helpful in reducing the number of pancreaticoduodenectomies performed for mere suspicion of cancer.”
Dual-phase CT findings of groove pancreatitis Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK Eur J Radiol. 2014 Aug; 83(8): 1337–1343. - “In conclusion, the diagnosis of GP may be difficult on MDCT and exclusion of malignancy such as pancreatic adenocarcinoma, ampullary and duodenal carcinomas is important. However, certain features seen on MDCT such as sheet like hypodensity in the PD groove, medial duodenal wall thickening and cystic changes in the duodenal wall along with evidence of chronic pancreatitis in the pancreatic head are highly suggestive of GP.”
Dual-phase CT findings of groove pancreatitis Zaheer A, Haider M, Kawamoto S, Hruban RH, Fishman EK Eur J Radiol. 2014 Aug; 83(8): 1337–1343.