role of computerized axial tomography [CT], ultrasonography [US], transhepatic cholangiography [PTC] and endoscopic retrograde cholangiopancreatography [ERCP] in differentiating inflammatory from malignant pancreatic focal mass lesion

ABSTRACT

Fifteen patients with focal inflammatory masses of the pancreas were thoroughly studied over 3-year period from 25 patients who have had suspected pancreatic disease. Ultrasound [US] and computerized axial tomography [CT] were performed as a screening. Subjective pancreatic enlargement and/or distortion [nodular or irregular contour] were detected in 15 cases. Transhepatic cholangiography [THC] was performed allowed a diagnosis of inflammatory disease in three patients demonstrating long smooth stricture of the common bile duct [CBD] and the 4th patient had a short, smooth stricture producing incomplete obstruction suggesting malignancy and in three the distal CBD was completely obstructed with rat- tail tapering highly suggestive of malignancy. Endoscopic retrograde cholangiopancreatography [ERCP] was successful in eight patients since they permitted pancreatitis in three, two patients malignancy could not be determined and three patients had findings usually associated with malignancy, two of them had complete obstruction of the pancreatic duct, while one had "double duct sign". The mass identified by CT usually of the same pancreatic attenuation, although five contained small areas of low attenuation suggesting inflammation. Ten patients with pancreatic head mass demonstrated obstructive jaundice. On US the inflammatory masses appeared hypoechoic. The pancreatic duct was identified sonographically in four of five patients seen by CT