MedPix Medical Image Database

COW - Case of the WeekCase Contributor: Johnathan l HadleyAffiliation: Eastern Virginia Medical School

MedPix No: 7688 - HistoryPt Demographics: Age = 64 y.o. Gender = manIntractable Nausea and Vomitting

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MedPix No: 7688 - EXAM & LABSNone available

Pancreatic adenocarcinoma

Image shows significant narrowing of the duodenal c-loop with concave bowing along the medial side

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Pancreatic adenocarcinoma

Placing the patient prone nicely demonstrates continued narrowing of the proximal duodenum with a normal diameter distal segment

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Pancreatic adenocarcinoma

CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.

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Pancreatic adenocarcinoma

CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.

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Pancreatic adenocarcinoma

CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.

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Pancreatic adenocarcinoma

CT of the abdomen shows a large mass in the head of the pancreas; note the normal diameter distal duodenum.

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FINDINGSUGI images demonstrate marked narrowing of the proximal segments of the duodenum as well as massive distention of the stomach. The concave deformity along the pancreatic margin of the duodenum has been refferred to as the *reverse three sign of Frostberg.*CT confirms a mass in the head of the pancreas with compression of the duodenum. Note the preservation of the distal duodenal lumen.

DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?From the UGI only:- Pancreatic Adenocarcinoma- Chron*s- Infiltrating lymphoma- Duodenal wall hemorrhage- Severe post-bulbar ulcer- Duodenal Carcinoma

Diagnosis: Pancreatic adenocarcinomaDx Confirmed by: CT guided biopsy

DISCUSSION