Korean J Gastroenterol.  2015 Apr;65(4):252-257. 10.4166/kjg.2015.65.4.252.

Pyogenic Pancreatic Abscess Mimicking Pancreatic Neoplasm: A Four-Case Series

• Kim MJ
• Seo E
• Kang ES
• Kim KM
• Oh YM
• Cho BH
• Kim HW
• Ji MJ
• Jeong JW
• Park SM

• KMID: 2373218
• DOI: http://doi.org/10.4166/kjg.2015.65.4.252

Abstract

A pyogenic pancreatic abscess mimicking pancreatic neoplasm in the absence of acute pancreatitis is rare. We report four patients who each presented with a pancreatic mass at the pancreas head or body without acute pancreatitis. The presenting symptoms were abdominal pain, fever, or weight loss. Abdominal CT scans showed low-density round masses at the pancreas head or body with/without lymphadenopathy. In each case, a PET-CT scan showed a mass with a high SUV, indicating possible malignancy. Comorbid diseases were identified in all patients: chronic pancreatitis and thrombus at the portal vein, penetrating duodenal ulcer, distal common bile duct stenosis, and diabetes mellitus. Diagnoses were performed by laparoscopic biopsy in two patients and via EUS fine needle aspiration in one patient. One patient revealed a multifocal microabscess at the pancreatic head caused by a deep-penetrating duodenal ulcer. He was treated with antibiotics and a proton-pump inhibitor. The clinical symptoms and pancreatic images of all the patients were improved using conservative management. Infective causes should be considered for a pancreatic mass mimicking malignancy.

Keyword

Pancreas; Abscess; Neoplasms; Endosonography

MeSH Terms

Abscess/*diagnosis
Aged
Diagnosis, Differential
Endosonography
Female
Humans
Laparoscopy
Male
Middle Aged
Pancreas/pathology
Pancreatic Diseases/*diagnosis/pathology/surgery
Pancreatic Neoplasms/*diagnosis/pathology/surgery
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Image studies of Case 1. (A) Axial view of the abdominal CT scan. A 2.7-cm ill-defined low-density mass (arrow) with peripancreatic fat infiltration was located at the pancreatic body. (B) Coronal view of the abdominal CT scan. An ill-defined, soft tissue density lesion around the celiac axis, common hepatic artery, splenic artery, and portal vein was noted (arrow). (C) PET-CT scan. Hot uptake (SUV 3.8) at the pancreatic body, indicating possible malignancy, was observed (arrow).

• 

  Fig. 2. Image studies of Case 2. (A) Axial view of the abdominal CT scan. A 5.0-cm well-defined low-density mass with heterogenous enhancement at the pancreas head (arrow), parenchymal atrophy, and a calcifying stone in the dilated pancreatic duct (arrowhead). (B) Coronal view of the abdominal CT scan. The portal vein and common hepatic artery were encased by a low-density mass (arrow). (C) Axial view of the abdominal CT scan after treatment. Resolution of the abscess was noted (arrowhead).

• 

  Fig. 3. Image studies of Case 3. (A, B) Axial and coronal views of the abdominal CT scan. A 1.2-cm well-defined low-density mass at the pancreatic head was observed (arrows). (C) Endoscopic ultrasonography. A 1.2-cm-sized anechoic round mass was seen at the pancreas head (arrows).

• 

  Fig. 4. Image studies of Case 4. (A) Axial view of the abdominal CT scan. A 1.7-cm multifocal ill-defined low-density lesion with multiple enhancing tubular structures at the head of the pancreas was observed (arrow). (B) PET-CT scan. Hot uptake (SUVmax 3.8) at the pancreatic head indicated possible malignancy or inflammation (arrow). (C, D) Endoscopic ultrasonography. A 2.8×1.6 cm-sized round isoechoic lesion with internal anechoic tubular structures was observed using vascular doppler (arrows). (E) Endoscopic finding. A 3.0-cm round deep-penetrating duodenal ulcer with a central pit was observed (arrow). (F) Endoscopic finding one year later. The duodenal ulcer had improved; however, the duodenal fistula remained (arrow).

Reference

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