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Abdomen » Pancreas

A very small tumor in the pancreatic head

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Author(s) :

Chaitali Shah, FRCR

Presentation A 78 year old woman presents with complaints of progressively increasing jaundice and with pain in the abdomen of one month duration. A transabdominal ultrasound was performed.

Caption: Sagittal scan in the region of the gallbladder.

Description: A distended gallbladder is noted. The common bile duct is dilated and shows abrupt termination. A rounded hypoechoic structure is seen distal to the duct.

Caption: Transverse image in the region of the gallbladder

Description: The rounded mass, which was seen in relation to the dilated common bile duct is noted again [between calipers]. The gallbladder shows the presence of a calculus.

Caption: Transverse view of the liver.

Description: Mild dilatation of the intrahepatic biliary radicles noted.

Caption: T2 weighted MRI image.

Description: The pancreatic head shows a very small intrapancreatic hypointense mass.

Caption: Transverse MRI image.

Description: The hypointense intra-pancreatic mass is seen again in this image.

Differential Diagnosis Terminal bile duct tumor, tumor in the head of pancreas, terminal bile duct calculus [although very unlikely]

Final Diagnosis A small tumor in the head of pancreas obstructing the terminal bile duct. This was an adenocarcinoma.

Discussion This case here highlights the importance of finding an abruptly terminating bile duct. The additional finding of an associated mass suggets that the disease process could either be a cholangiocarcinoma of the terminal duct or a pancreatic tumor. Further imaging would help to arrive at a final diagnosis.

Follow Up Further imaging [ERCP and MRI] was performed which showed a small mass in the head of the pancreas, just next to the terminal portion of the CBD, obstructing it. This mass proved to be an adenocarcinoma and the patient was operated upon.

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