CECT of a 45-year-old man with obstructive jaundice and raised serum IgG4 shows diffuse sausage-shaped enlargement of the pancreas with loss of its normal lobulated contour, delayed homogeneous enhancement, and a low attenuation rim around the gland. The most likely diagnosis is:

• A Autoimmune pancreatitis type 1 ✓
• B Groove pancreatitis
• C Pancreatic ductal adenocarcinoma of the body
• D Lymphoplasmacytic pseudotumour of the uncinate process

Explanation

Diffuse sausage-shaped pancreatic enlargement with delayed homogeneous enhancement and a capsule-like hypodense halo is the classic CT appearance of type 1 autoimmune pancreatitis, an IgG4 related disease. The capsule-like rim represents fibroinflammatory extension beyond the gland and is highly characteristic. Adenocarcinoma typically causes focal hypovascular mass with abrupt duct cutoff rather than diffuse smooth enlargement, and groove pancreatitis selectively involves the pancreaticoduodenal groove between the head and duodenum.

Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.