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Imaging of the Pancreas and

Spleen

Linda P-Brown, MD

King Chulalongkorn MemorialHospital, Bangkok

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Case 1

A 53-year-old man presented with

abdominal pain, nausea and vomiting.

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Case 1

CT: Total necrosis with fat strandings

CTSI (CT severity index) = 8 (necrosis 6

+ fat stranding 2)

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Case 1

Acute pancreatitis CT grading based upon acute collection

and area of necrosis

Acute fluid collection Normal, 0

Edema, 1

Edema with fat strandings, 2 One fluid collection, 3

> one fluid collections or gas, 4

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Case 1

Acute pancreatitis Area of necrosis

No necrosis, 0

< 30%, 2

30-50%, 4

> 50%, 6

Combination of acute fluid collection and area

of necrosis = CTSI (CT severity index) The higher is the score, the worse is the

prognosis.

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Case 2

A 34-year-old male presented with

abdominal pain.

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Case 2

Chronic pancreatitis with pseudocysts

Risk factor: gallstone

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Case 3

A 65-year-old woman, check up.

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Case 3

Multiple simple pancreatic cysts, possibly

congenital.

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Case 4

A 67-year-old male presented with

abdominal pain.

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Case 4

Intraductal papillary mucinous tumor

(IPMT), combined type

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Case 5

A 67-year-old male presented with

abdominal pain.

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Case 5

IPMT, combined type

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Case 6

A 65-year-old male presented with

abdominal pain.

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Case 6

IPMT, main type

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Case 7

A 75-year-old female presented with

abdominal discomfort.

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Case 7

Microcystic adenoma

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Case 8

A 37-year-old female presented with

abdominal distension.

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Case 8

Mucinous cystic tumor

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Case 9

A 54-year-old man presented with

abdominal pain and jaundice.

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Case 9

Double duct sign

Pancreatic cancer encasing SMA, SMV

(T3) with liver metastasis (M1)

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Case 10

A 49-year-old man presented with

abdominal pain and jaundice.

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Case 10

Pancreatic cancer with liver metastasis

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Case 11

A 16-year-old female presented with

abdominal distension.

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Case 11

Non-functioning islet cell tumor

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Case 12

A 21-year-old man presented with

chronic abdominal pain.

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Case 12

Z-E syndrome from gastrinoma

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Case 13

A 23-year-old female presented with

multiple attack of acute pancreatitis.

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Case 13

Pancreatic divisum

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Case 14

A 78-year-old female presented with

abdominal pain and fever.

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Case 15

A 28-year-old male with accident.

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Case 15

Splenic laceration with pseudoaneurysm

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Conclusion

Pancreas

Severe acute pancreatitis

Chronic pancreatitis and pseudocysts

Congenital/simple cysts

Cystic tumors

Mucinous cystic tumor Microcystic adenoma

IPMT

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Conclusion

Pancreas

Adenocarcinoma

Endocrine tumor Non-functioning islet cell tumor

Gastrinoma

Pancreatic divisum

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Conclusion

Spleen

Abscess

Injury with pseudoaneurysm