ZSFG GI report – Pancreatic cysts

Happy Friday, fabulous humans! In ZSFG GI report we reviewed the fascinating case of a young woman  who came in after blunt abdominal trauma and was found to have (likely unrelated) a large, cystic infected pancreatic tail mass.
There’s still a lot unknown in this case, like whether her cyst actually arose from the kidney. Regardless. This was a great opportunity to review the anatomy of the pancreatic tail and the differential for cystic pancreatic masses.
The pancreatic tail
  • There are two retroperitonal compartments. The Kidneys are ensconced in a thick layer of fascia (gerota’s fascia” that separates them from their neighbors.
  • The pancreatic tail lays a separate compartment closely approximated with the spleen.
Pancreatic tail mass ddx
  • neoplasm (see more detail below)
  • pseudocyst
    • usually a sequela or old pancreatitis or trauma
  • hematoma
  • abscess
    • typical bacterial organisms
    • TB
    • fungi
  • sterile or infected pancreatic necrosis in s/o pancreatitis
Identifying what’s what often requires an interdisciplinary conversation between radiologists, surgeons, gastroenterologist sand yourself.
Pancreatic cystic neoplasms
  • Common incidentalomas (seen on 2% of cross sectional imaging!!) that pose a challenging clinical dilemma – many are benign, while some have high malignant potential and need to be resected.
  • 4 WHO classes
    • serous cystic tumor
    • mucinous cystic neoplasm
    • intraductal papillary neoplasm
    • solid pseudopapillary neoplasm
Want to know more?
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