A 58-year-old man with painless obstructive jaundice and a 15 kg weight loss over 3 months undergoes a pancreatic-protocol CT (biphasic with thin cuts through the pancreas). The MOST characteristic finding of pancreatic ductal adenocarcinoma in the head of the pancreas is:
- A A hypodense mass with abrupt cutoff of the dilated upstream main pancreatic duct and common bile duct dilatation ✓
- B A homogeneously enhancing hypervascular mass in the arterial phase
- C Calcifications within the mass with a chain-of-lakes appearance of the pancreatic duct
- D Diffuse gland enlargement with a capsule-like rim and delayed enhancement
Correct answer: A. A hypodense mass with abrupt cutoff of the dilated upstream main pancreatic duct and common bile duct dilatation
Explanation
Pancreatic adenocarcinoma classically appears as a hypodense (hypovascular) mass on the parenchymal phase with abrupt cutoff and upstream dilatation of the main pancreatic duct (often >5 mm), along with common bile duct dilatation. Calcifications and chain-of-lakes pattern indicate chronic pancreatitis. Hypervascular enhancement suggests neuroendocrine tumor. Diffuse enlargement with a capsule-like rim is typical of autoimmune pancreatitis.
Reference: Gastrointestinal Imaging (Gore and Levine), Standard edition ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.