A 60-year-old man with painless jaundice and weight loss undergoes contrast-enhanced CT, which shows a hypodense mass in the head of the pancreas with loss of the fat plane around the superior mesenteric artery and occlusion of the superior mesenteric vein. The mass shows delayed progressive enhancement. The MOST likely diagnosis is:

• A Pancreatic ductal adenocarcinoma ✓
• B Autoimmune pancreatitis
• C Pancreatic neuroendocrine tumor
• D Groove pancreatitis

Explanation

Pancreatic ductal adenocarcinoma is hypovascular and shows delayed progressive enhancement due to its desmoplastic stroma. Vascular encasement (SMA) and venous occlusion (SMV) are hallmarks of unresectable adenocarcinoma. Neuroendocrine tumors are hypervascular in the arterial phase. Autoimmune pancreatitis shows diffuse gland involvement with a capsule-like rim and does not occlude vessels. Groove pancreatitis involves the pancreaticoduodenal groove without vascular occlusion.

Reference: Abdominal Imaging (Federle), Standard edition ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.