Radiology Teaching Files > Case 3433889

Contributed by: lisa tornabene, Advocate Lutheran General Hospital, Illinois, USA.
Patient: 51 year 10 month 1 day old male

51 year old male presents with painless jaundice,loss of appetite and RUQ pain.
No prior marked clinical history or imaging modality exams.


Fig. 1: The common bile duct is dilated measuring 13.0 mm in diameter.

Fig. 2: Longitudinal/LLD image of the right lobe of the liver showing intrahepatic duct dilatation.

Fig. 3: Transverse image of the pancreas revealing the hypoechoic sonodensity involving the head of the pancreas
Findings: Images of the gallbladder (not presented here) show an internal echogenic focus with shadowing consistent with a gallstone. The common bile duct is dilated measuring 13.0 mm in diameter. 8.0 mm is considered upper limits of normal. There is also intrahepatic biliary duct dilatation. The common duct is dilated down into the region of the head of the pancreas where there is a hypoechoic sonodensity involving the head of the pancreas supspicious for a pancreatic mass. The pancreatic duct also appears prominent.   

A CT of the abdomen and pelvis was performed 2 weeks later.
The pancreatic duct was mildly dilated and measured 5 mm in caliber. The mass at the head of the pancreas was  discrete. There were enlarged peripancreatic lymph nodes superior to the pancreas which measured about 8 mm in shortest axis. These were numerous. Evaluation of the lung bases revealed a 5-mm noncalcified pulmonary nodule in the right lung base which may be neoplastic or inflammatory in nature.


Pancreatic cancer is the fourth most common cancer in men and the fifth most common in women in the U.S. It occurs nearly twice as often in men as women, but rarely develops before
age 50. It is two to three times more common in heavy smokers than in non-smokers. People who have chronic pancreatitis are at a higher risk of developing pancreatic cancer.
Pancreatic cancer usually causes no symptoms until the tumor is large. At that point, the cancer has usually spread to nearby lymph nodes, the liver or the lungs. The first symptoms are usually abdominal pain and weight loss. About 80% of pancreatic cancers occur in the head of the pancreas. Jaundice occurs when the bile duct becomes obstructed. Other symptoms include mid back pain, nausea and diarrhea, general weakness, itchy skin,light colored bowel movements and slow digestion of food. The liver and gallbladder may be swollen. 

The most common pancreatic malignant lesion is ductal adenocarcinoma. Few patients with this tumor are surgical candidates at presentation because of vascular encasement or metastatic disease. Patients with small tumors (less than 2cm) that have no vascular invasion or lymph node metastasis have the best prognosis. The 5 year survival rate after pancreatoduodenectomy is between 18% and 33%.

Intraoperative sonography can be used to detect and determine the extent of a small,nonpalpable pancreatic mass. Pancreatic ductal adenocarcinoma is usually a hypoechoic,solid mass with irregular margins. It frequently obstructs the pancreatic duct and common bile duct and causes ductal dilation up to the level of the mass. IOS can also be used to detect abnormal regional lymph nodes, vascular encasement by neoplasm, and liver metastatic lesions.Demonstrating occult liver metastatic lesions with IOS can prevent an unnecessary attempt at surgical resection.


Milton S. Hershey Medical Center, Penn State College of Medicine

Intraoperative and Laparoscopic Sonography of the Abdomen

nice case--barbara grams, 2005-12-15
Additional Details:

Case Number: 3433889Last Updated: 12-15-2005
Anatomy: Other   Pathology: Other
Modality: USExam Date: 10-12-2005Access Level: Readable by all users
Keywords: pancreatic cancer/dilated common duct

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