Spectrum of Causes of Pancreatic Calcifications
Robert J. Lesniak1,
Mark D. Hohenwalter1 and
Andrew J. Taylor2
1
Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave.,
Milwaukee, WI 53226-3596.
2
Department of Radiology, University of Wisconsin Medical School, 600 Highland
Ave., Madison, WI 53792-3252.
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Fig. 1A. —Calcifications associated with chronic alcoholic
pancreatitis. Radiograph of abdomen of 57-year-old man with chronic abdominal
pain shows numerous dense calcifications over pancreatic area. Subsequently,
history of chronic alcohol abuse was obtained.
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Fig. 1B. —Calcifications associated with chronic alcoholic
pancreatitis. Contrast-enhanced CT of abdomen in 58-year-old man with history
of alcohol abuse who presented with jaundice. In this case, calcifications in
enlarged pancreatic head and biliary tree dilatation are due to pancreatitis.
Rarely, pancreatic adenocarcinoma can be associated with ductal
calcifications. However, pancreatitis is more common.
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Fig. 1C. —Calcifications associated with chronic alcoholic
pancreatitis. Contrast-enhanced CT of abdomen in 58-year-old man with history
of alcohol abuse who presented with jaundice. In this case, calcifications in
enlarged pancreatic head and biliary tree dilatation are due to pancreatitis.
Rarely, pancreatic adenocarcinoma can be associated with ductal
calcifications. However, pancreatitis is more common.
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Fig. 1D. —Calcifications associated with chronic alcoholic
pancreatitis. Transverse sonogram of pancreas in 52-year-old man with chronic
alcoholic pancreatitis displays some large concretions that shadow (curved
arrow). However, many smaller stones are represented as bright reflectors
but without accompanying sonic shadow (arrowhead). This is a common
finding. Also present are segments of abnormally dilated pancreatic duct
(arrow).
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Fig. 2A. —Hereditary pancreatitis in 18-year-old man with abdominal
pain and distended abdomen. His brother was previously diagnosed with
hereditary pancreatitis. On endoscopic retrograde pancreatogram, large
intraductal concretions (arrows) are present.
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Fig. 2B. —Hereditary pancreatitis in 18-year-old man with abdominal
pain and distended abdomen. His brother was previously diagnosed with
hereditary pancreatitis. On subsequent contrast-enhanced CT, calcified
concretions in pancreatic body and tail are seen. Massive ascites is
pancreatic in origin.
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Fig. 3A. —Cystic fibrosis in 23-year-old woman. Contrast-enhanced CT
scan shows small pancreatic calcifications (arrows) throughout
gland.
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Fig. 3B. —Cystic fibrosis in 23-year-old woman. Contrast-enhanced CT
scan shows small pancreatic calcifications (arrows) throughout
gland.
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Fig. 4A. —Adenocarcinoma superimposed on chronic calcific pancreatitis
in 71-year-old woman with history of alcohol abuse who presented with
jaundice. On CT scan, pancreatic head contains calcifications displaced by
poorly defined mass (arrows).
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Fig. 4B. —Adenocarcinoma superimposed on chronic calcific pancreatitis
in 71-year-old woman with history of alcohol abuse who presented with
jaundice. Radiograph of pancreatic head obtained before injection on
endoscopic retrograde pancreatogram shows these calcifications to be in form
of ducts (arrow). Subsequent biopsy reveals carcinoma in head of
pancreas.
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Fig. 5A. —Calcifications develop upstream from malignant obstruction in
81-year-old woman who presented with epigastric pain. Patient had no history
of alcohol abuse. On CT scan, small calcification is present in dilated main
pancreatic duct (arrow). Also note dilated intrahepatic biliary
ducts.
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Fig. 5B. —Calcifications develop upstream from malignant obstruction in
81-year-old woman who presented with epigastric pain. Patient had no history
of alcohol abuse. On endoscopic retrograde pancreatogram, ductal concretion
(arrow) is present behind malignant stricture. Pancreatic carcinoma
was found at surgery.
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Fig. 6. —Nonhyperfunctioning islet cell tumor in 41-year-old woman who
presented with vague epigastric pain. Complex mass is found on
contrast-enhanced CT scan. Note central calcifications and low-attenuation
areas of necrosis in mass. Absence of biliary ductal dilatation is unusual for
pancreatic adenocarcinoma in this location. Subsequent biopsy confirmed
diagnosis of non-hyperfunctioning islet cell tumor.
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Fig. 7A. —Insulinoma in 24-year-old woman who presented with
hypoglycemia. Because of clinical likelihood of insulinoma, noncontrast CT
scan was initially obtained. Subtle 2.0 x 3.0 cm area of high
attenuation in pancreas (arrow) is found to represent calcified
insulinoma at surgical pathology.
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Fig. 7B. —Insulinoma in 24-year-old woman who presented with
hypoglycemia. Tumoral hypervascularity is seen as blush with contrast
enhancement.
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Fig. 8A. —Intraductal papillary neoplasm in 52-year-old woman with
pancreatic stent recently placed for pancreatitis outside our institution.
Radiograph obtained before endoscopic retrograde pancreatogram shows
pancreatic stent adjacent to moderate-sized focus of calcification with
smaller calcifications (arrows) also visualized.
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Fig. 8B. —Intraductal papillary neoplasm in 52-year-old woman with
pancreatic stent recently placed for pancreatitis outside our institution.
Contrast-enhanced CT scan depicts dominant calcification in pancreatic head
(arrow) and smaller flecks of calcium (arrowheads). On
endoscopic retrograde pancreatogram (not shown), other, noncalcified, mucinous
filling defects were seen.
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Fig. 9A. —Mucinous cystic neoplasm in 79-year-old woman with pancreatic
mass found during imaging workup for lower back pain. Noncontrast CT scan was
obtained because of renal compromise. Mucinous cystic neoplasm has small
linear focus of calcification in its wall (arrow).
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Fig. 9B. —Mucinous cystic neoplasm in 79-year-old woman with pancreatic
mass found during imaging workup for lower back pain. Fast spin-echo
T2-weighted MR image better displays internal network of septations. However,
as is common with MR imaging, mural calcification is not seen.
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Fig. 10. —Serous cystadenoma in 65-year-old woman with mass in
pancreatic head. Delayed contrast-enhanced CT scan shows nodular pancreatic
mass with honeycombed appearance (arrow). Central scar is only
faintly calcified.
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Fig. 11A. —Solid and pseudopapillary epithelial neoplasm in 34-year-old
woman with back pain. Left upper quadrant curvilinear calcifications are shown
on lateral radiograph of lumbar spine.
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Fig. 11B. —Solid and pseudopapillary epithelial neoplasm in 34-year-old
woman with back pain. Subsequent contrast-enhanced CT scans define
calcification as part of pancreatic mass. Portion of this mass is soft tissue
(arrow), whereas second component appears as peripherally calcified
cyst (arrowhead).
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Fig. 11C. —Solid and pseudopapillary epithelial neoplasm in 34-year-old
woman with back pain. Subsequent contrast-enhanced CT scans define
calcification as part of pancreatic mass. Portion of this mass is soft tissue
(arrow), whereas second component appears as peripherally calcified
cyst (arrowhead).
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Fig. 12. —Pancreatic metastases in 63-year-old man with mucinous colon
carcinoma. Contrast-enhanced CT scan shows pancreatic mass with calcification
(straight arrow) present with similar calcifications in liver
(curved arrows). Biopsies showed both liver and pancreatic lesions
were metastatic.
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Fig. 13A. —Senescent pancreatic calcifications in 77-year-old man
without significant medical history who presented with steatorrhea. CT section
through body and tail of pancreas shows tiny peripheral calcifications
(arrowheads). Also apparent is glandular atrophy and main duct
dilatation.
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Fig. 13B. —Senescent pancreatic calcifications in 77-year-old man
without significant medical history who presented with steatorrhea. CT scan on
slightly more caudad section shows that large intraductal calculus
(arrow) is cause of ductal obstruction.
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Fig. 14A. —Splenic artery mimic in 51-year-old woman with no symptoms
relating to her pancreas. Portal venous phase contrast-enhanced CT scan shows
ring-like area of high attenuation in pancreas (arrow). Question of
small islet cell tumor with peripheral calcification was raised. At least one
area is definitely calcified (arrowhead).
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Fig. 14B. —Splenic artery mimic in 51-year-old woman with no symptoms
relating to her pancreas. Patient was brought back for double-helical CT scan
using thinner slice section. Sections during arterial phase of this
examination better show tortuous splenic artery that indents into normal
pancreas.
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Fig. 15A. —Contrast-enhanced intrapancreatic artery mimicking
calcification in 5-year-old girl who presented with pancreatitis. On
contrast-enhanced CT scan, small focus of increased attenuation was thought to
be pancreatic calcification (arrow). Possibility of hereditary
pancreatitis was raised. Normal endoscopic retrograde cholangiopancreatogram
followed (not shown).
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Fig. 15B. —Contrast-enhanced intrapancreatic artery mimicking
calcification in 5-year-old girl who presented with pancreatitis. Subsequent
unenhanced CT scan was obtained that showed normal-appearing pancreas and
failed to visualize any pancreatic calcification verifying that area of
increased attenuation on initial examination was intrapancreatic vessel.
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Fig. 16. —64-year-old man with abdominal pain. Contrast-enhanced CT
scan shows distal common bile duct stone (arrow) masquerading as
pancreatic calcification.
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Copyright © 2002 by the American Roentgen Ray Society.
