MyPACS.net: Radiology Teaching Files > Case 2951991

never visited DIFFUSE PANCREATIC FATTY INFILTRATION
Contributed by: Arman Forouzannia, Resident, Virginia Mason Medical Center, Washington, USA.
Patient: 38 year old female
History: 38 year old female present to PCP with vague abdominal pain and bloating. No signifanct past medical history except migraines.
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Findings: There is absence of glandular pancreatic tissue. Rather, the pancreatic region has been replaced by marked diffuse hypoattenuation tissue with the same density as the intra-abdominal fat. This finding is most often seen with Cystic Fibrosis. Patients with Insulin dependent diabetes may also present with this finding.
Diagnosis: Idiopathic Lipomatamous Pseudotumor of the Pancreas.
Discussion:

While these findings of diffuse fatty replacement of the pancreas raise the suspicion of CF, the patients medical history was relatively benign and given the patients somewhat advanced age it is highly unlikely that this represents CF. Rather, this is simply fatty change or lipomatous pseudotumor of the pancreas.

The patient was referred for testing for cystic fibrosis however, which was negative.

Uniform fatty replacement of the exocrine pancreas is the most frequent CT finding in adolescent and adult patients with CF. Although this change tends to occur more often in older patients and represents a late phenomenon, it can also be found earlier in the course of the disease. In the most advanced stages of CF, the exocrine tissue of the pancreas is replaced by fat.

In microscopic terms, the parenchyma consists of mature adipose tissue separated by fibrous septa and contains isolated clusters of islets of Langerhans. Typically, no residual exocrine tissue are evident except for a few remaining pancreatic ductules.

References:

Cystic Fibrosis in Adolescents and Adults: Fatty Replacement of the Pancreas—CT Evaluation and Functional Correlation Radiology, Mar 1999; 210: 611 - 615.

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Additional Details:

Case Number: 2951991Last Updated: 11-03-2005
Anatomy: Gastrointestinal (GI)   Pathology: Normal/Variants
Modality: CTExam Date: 01-01-2000Access Level: Readable by all users
Keywords: cystic fibrosis, pancreas, fatty change, lipomatous, pseudotumor

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