Angiographic evaluation of the abnormal endoscopic pancreatogram

Abstract

Out of 1,269 pancreatograms, 122 were abnormal. Angiography was performed in these patients. Fifty-five were found to have pancreatic carcinoma. In the remaining 67 patients a false positive angiographic diagnosis of either chronic pancreatitis or pancreatic cancer was made in 11%. In one patient a hemangioma was diagnosed as a pancreatic cyst. The remaining 58 patients all had normal pancreatic angiograms in spite of gross ductal abnormality on endoscopic retrograde cholangiopancreatography (ERCP). All these patients were followed for an average of 19 months and showed no clinical evidence of pancreatic disease. It is suggested that angiography should be considered a complementary examination to ERCP and is particularly useful to exclude carcinoma when the pancreatogram is abnormal.

Pseudotumorous pancreatitis

“…Furthermore, localized pancreatitis in the immediate vicinity of a carcinoma [14][15][16] can present angiographically as focal hypervascularity [14,17] or as a mass on CT [18]. If clinical symptoms and laboratory findings indicate the presence of an islet cell tumor, the differential diagnosis from focal pancreatitis can become difficult not only by means of radiologic [13,19,20] but sometimes also by histologic study because of the relative increase in the number and size of the islets of Langerhans. In rare instances, proliferated insular cells can be in direct contact with nerve fibers or may even enter into the perineural space, giving the impression of early invasive carcinoma [1,21,22].…”