3 Contrast enhanced abdominal CT scan at the pancreatic phase showing a normal pancreas

3 Contrast enhanced abdominal CT scan at the pancreatic phase showing a normal pancreas. Discussion Autoimmune pancreatitis (AIP) is a rare clinical entity. of the pancreas help in making the diagnosis. Imaging, especially Magnetic resonance cholangiopancreatography (MRCP) plays an important role in the diagnosis of AIP, as it gives detailed information about pancreatic parenchyma and ducts, highlighting some characteristic indicators of AIP. MRCP typically shows multiple skipped narrowings of the main pancreatic ducts (MPD) without dilation of the upstream MPD.A fibrous halo can also be seen round the pseudo mass [1,2]. Case statement A 53-year-old female, with no history of alcohol misuse or additional predisposing factors for chronic pancreatitis, presenting with PDE12-IN-3 transfixing epigastric pain evolving for 10 days associated with the progressive onset of mucous and cutaneous jaundice with pale stools and PDE12-IN-3 dark urine. She experienced moderate deterioration in general condition and excess weight loss (3kg). Medical examination found out apyretic patient with mucocutaneous icterus and epigastric tenderness. The rest of the physical exam was normal. The biological analysis showed bilirubin 97 mol / L alanine aminotransferase (ALT) 300 IU / L, aspartate aminotransferase (AST) 155 IU / L, -glutamyl transpeptidase (GGT) 500 IU / L, Tumor marker ideals: CA19-9?=?90 U / ml. A contrast enhanced abdominal CT scan in the pancreatic phase was performed showing a hypodense pancreatic head mass, little enhanced respecting the vascular constructions with infiltration of peri-pancreatic excess fat, measuring 23??18mm (Fig,. 1), suggesting a resectable adenocarcinoma of the head of the pancreas. Open in a separate windows Fig. 1 Contrast enhanced abdominal CT scan in the pancreatic phase showing a hypodense pancreatic head mass, little enhanced respecting the vascular constructions with infiltration of peri-pancreatic excess fat. A contrast enhanced abdominal CT scan in the pancreatic phase was performed showing a hypodense pancreatic head mass, little enhanced respecting the vascular constructions with infiltration of peri-pancreatic excess fat (Fig.?1), suggesting a resecable adenocarcinoma of the head of the pancreas. Further imaging with MRCP showed a pancreatic head mass hypointense on T1 and T2 weighted sequences, with diffusion coefficient restriction, surrounded by a capsule of hypointensity on T1 and T2 weighted sequences with slight enhancement after injection of gadolinium, measuring 23??18mm. There was irregular narrowing of the main pancreatic duct which was not clearly visualized in the pancreatic head (Fig.?2). Open in a separate windows Fig. 2 (a): T1 weighted MR On a pancreatic-phase of dynamic contrast-enhanced image showing the main pancreatic duct which is definitely partially unclear in the head of the pancreas (arrow). (b): T1-weighted MR images showing a nodular lesion in the pancreatic head surrounded by hypointense capsule-like rim (arrow). (c): diffusion weighted image (b?=?800) showing a nodular hyperintense lesion in the pancreatic head (arrow). (d): MRCP showing irregular narrowing of the main pancreatic duct (arrow). The features recognized after the MRCP were in keeping with the analysis of focal autoimmune pancreatitis. An IgG4 assay was performed showing a high rate of 1 1.65 g / l. The patient underwent corticosteroid therapy with a good medical development and regression of the morphological abnormalities observed during a CT scan control (Fig.?3). Open in a separate windows Fig. 3 Contrast enhanced abdominal CT scan in the pancreatic phase showing a normal pancreas. Conversation Autoimmune pancreatitis (AIP) is definitely a rare medical entity . The analysis is based on medical, radiological, serological and histological criterias. In the majority of cases, risk factors for chronic pancreatitis or alcohol dependence are missing [1]. It can manifest clinically as PDE12-IN-3 acute epigastric pain associated with theprogressive onset of weight loss with cutaneous mucosal jaundice PDE12-IN-3 [1,2]. You will find 2 types of AIP: Type 1 AIPs related to IgG4 sclerosing disease, which is definitely more frequent in individuals over 50-60 years old, with male predominance. Its histological peculiarities are a dense per-ductal lymphoplasmacytic infiltrate, pancreatic fibrosis and obliterating venulitis. Serum immunoglobulins are greatly elevated and cause multi-organ damage (primarily biliary IBP3 damage). Type 2 AIP, which is definitely more common in 40-year-olds, is definitely often associated with additional autoimmune diseases such as sclerosing cholangitis, chronic inflammatory bowel disease, Gougerot-Sj?gren Syndrome, thyroiditis, diabetes and retroperitoneal fibrosis. In this type, serum immunoglobulin PDE12-IN-3 levels are normal [1,3]. There are numerous and varied biological markers of AIP: rheumatoid element antinuclear antibody (ANA), anticarbonic anhydrase antibody-II, antilactoferrin antibody,.