A Case of Acute Pancreatitis Mimicking Pancreatic Malignancy

Clinical History

A 62-year old man presented with symptoms of right upper quadrant abdominal pain, vomiting, raised inflammatory markers, and deranged LFT.

An abdominal ultrasound was requested as a first line of imaging to assess for features of cholecystitis.

Case Description

Ultrasound revealed a large heterogeneous cystic structure within the epigastrium posterior to the duodenum, with no internal vascularity seen in the structure. Although the pancreas was not clearly visualised on this examination, the said cystic structure was suggested to be related to the pancreas, due to its proximity. In addition, there was also a mild trace of ascites in the hepatorenal pouch of Morrison, right and left iliac fossae, with the thin-walled gallbladder containing some sludge within its lumen.

Due to these findings, an urgent review was advised.

Diagnosis/ Discussion/ Treatment/ Follow up

The patient was referred to have a contrast-enhanced CT scan of the whole body which confirmed the presence of a large heterogeneous mass replacing the head and body of pancreas. The mass was seen to have a cystic/ necrotic component. Suggestive of a pancreatic tumour (Acute Pancreatitis).

However, the patient’s blood results and clinical evaluation were more inflammatory than tumoral.

The patient had ERCP, cytology, and endoscopic ultrasound (EUS), which aided the diagnosis of acute pancreatitis. A follow up whole body CT scan 3 months post treatment confirmed resolution of the pancreatic collection in keeping with chronic (acute Pancreatitis) pancreatitis.