Cystic Lesions of the Pancreas

http://www.ajronline.org/cgi/content/full/179/6/1375

Terrence C. Demos 1 ; Harold V. Posniak 1 ; Carla Harmath 1 ; Mary C. Olson 1 ; Gerard Aranha 2

1 Department of Radiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153.
2 Department of Surgery, Surgical Oncology Section, Loyola University Medical Center, Maywood, IL 60153.
Received January 23, 2002; accepted after revision March 19, 2002.
Presented at the annual meeting of the American Roentgen Ray Society, Seattle, April-May 2001.

Cystic pancreatic lesions are regularly encountered on imaging studies of patients who are symptomatic or as unexpected abnormalities in patients who are being examined for other easons. A wide variety of cystic lesions of the pancreas are seen, but pseudocysts are by far most common. Cystic neoplasms are often misdiagnosed as pseudocysts, which occurred in 22 of 67 patients in one series [1]. This indicates the difficulty in diagnosis and at the same time emphasizes the need to obtain clinical information to provide the most accurate diagnosis by consulting with the referring physician regarding virtually every patient who is found to have a pancreatic mass. In addition, knowledge of fundamental clinical [2,3,4,5], pathologic [2], laboratory, and imaging [6,7,8,9,10,11] information related to specific cystic pancreatic lesions can be used to decrease misdiagnosis, to narrow the differential diagnosis, or, in some cases, to provide a diagnosis.

In this review, a gamut of pancreatic and parapancreatic masses is illustrated and arranged according to disease category. Basic clinical, pathologic, and imaging features are presented. Pancreatic lesions are imaged with CT [6,7,8], sonography [9, 11], MR imaging [10], endoscopic retrograde cholangiopancreatography (ERCP), and angiography. In this article we emphasize CT because most lesions are either discovered or evaluated on CT.