A 62-year-old male presented with painless jaundice and solitary pulmonary and pancreatic masses. An extensive evaluation revealed Wegener's granulomatosis as the etiology. His pancreatic mass and jaundice responded to temporary stenting and therapy with cyclophosphamide and prednisone. While pancreatic vasculitis in Wegener's granulomatosis has been noted previously in autopsy studies, symptomatic involvement has been reported only once previously and never as a presenting feature of the disease. The antineutrophil cytoplasmic antibody (ANCA) assay proved useful in establishing the diagnosis. Necrotizing vasculidities can mimic pancreatic carcinoma and should be considered in the differential diagnosis of atypical cases.

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Fig. 3. Sagittal CT abdomen/pelvis image of caecal volvulus incarcerated through epiploic foramen and compressing the IVC.