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)
- usually a sequela or old pancreatitis or trauma
- typical bacterial organisms
- 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?
- The AGA has great guidelines on evaluating and managing these neoplasms here: http://www.gastro.org/guidelines/pancreatic-cysts
- Everything you ever wanted to know about the pancreas (and the source of the image above) https://www.pancreapedia.org/reviews/introduction-to-pancreatic-disease-acute-pancreatitis