Pancreatic Cancer Masked by Acute Pancreatitis as well as an Unusual Iatrogenic Complication

Abstract

A 62‑year‑old female presented with abdominal pain and was diagnosed as acute on chronic pancreatitis based on elevated serum amylase and imaging findings. The pancreatic duct was dilated with abrupt cutoff at neck of pancreas, but no mass was visualized. Positron emission tomography‑computed tomography (PET‑CT) revealed a fluorodeoxyglucose (FDG) avid lesion in the neck of the pancreas but ultrasound (USG)‑guided fine‑needle aspiration (FNA) from the lesion revealed only inflammatory cells. Endoscopic ultrasound, done 2 days after USG‑guided FNA, revealed pseudoaneurysm (PA) in the neck of pancreas that was confirmed on CT angiography. The PA was occluded by USG‑guided percutaneous cyanoacrylate injection. As pain persisted, repeat PET CT was done which revealed FDG avidity around the cyanoacrylate cast as well in multiple small hypodense lesions in the right lobe of the liver. USG‑guided FNA from both the liver lesion as well as the periphery of the glue cast revealed features of adenocarcinoma. We herein report a case of pancreatic adenocarcinoma that presented as acute pancreatitis and got masked because of formation of PA consequent to USG‑guided FNA.