Pankreasverkalkungen
Multiple
Pankreasverkalkungen bei chronischer Pankreatitis, links koronar und axial in der Computertomografie, rechts in der Röntgenaufnahme.
Chronische
Pankreatitis mit multiplen kleinen Verkalkungen als Nebenbefund beim Lungenembolie-CT
Chronische
Pankreatitis mit multiplen Verkalkungen in der Computertomographie.
Autoimmune
pancreatitis can develop into chronic pancreatitis. CT findings in a 67-year-old woman with pancreatic head swelling. (A) CT at diagnosis in May 2005 showing pancreatic head swelling (arrows). (B), (C) CT 27 months later in August 2007 showing pancreatic stone formation and pancreatic atrophy (arrows). Data are reprinted from Ref. [41] with permission from the Journal of Gastroenterology.
Autoimmune
pancreatitis can develop into chronic pancreatitis. ERCP and CT findings in a 69-year-old man with narrowing of both Wirsung’s and Santorini’s ducts. (A) ERCP at diagnosis in April 2001 showing Wirsung and Santorini duct narrowing (arrowheads). (B), (C) CT 105 months later in December 2009 showing pancreatic stone formation and pancreatic atrophy (arrow). Data are reprinted from Ref. [41] with permission from the Journal of Gastroenterology.
Autoimmune
pancreatitis can develop into chronic pancreatitis. Images of AIP exhibiting definite chronic pancreatitis, and findings of AIP demonstrating independent risk factors for progression to chronic pancreatitis. (A) CT image of stones in pancreatic ducts (arrow). (B) CT image of multiple or numerous calcifications distributed throughout the entire pancreas (arrows). CT and ERCP findings of AIP demonstrating independent risk factors for progression to confirmed chronic pancreatitis at diagnosis. (C) CT finding of pancreatic head swelling at AIP diagnosis (arrows). (D) ERP finding of MPD non-narrowing in the pancreatic body at AIP diagnosis (arrowheads). (From Ref. [54]).
Autoimmune
pancreatitis can develop into chronic pancreatitis. Sequential progression mechanism of AIP to confirmed chronic pancreatitis. (A) Narrowing of both Wirsung’s and Santorini’s ducts (arrows) by pancreatic head swelling causes pancreatic juice stasis in the upstream pancreatic duct. (B) Pancreatic juice stasis results in increased intra-pancreatic duct pressure that is resistant to typical AIP-specific MPD narrowing in the pancreatic body region, leading to MPD non-narrowing in this region (arrowheads). (C) In concert with relapse, these events finally result in severe calcification. (From Ref.[54]).
Chronic
pancreatitis • Pancreatic calcifications in chronic pancreatitis - Ganzer Fall bei Radiopaedia
Pancreatic
calcifications • Senescent pancreatic calcifications - Ganzer Fall bei Radiopaedia
Cystic
fibrosis • Pancreatic calcification with cystic fibrosis - Ganzer Fall bei Radiopaedia
Pancreatic
calcifications • Pancreatic calcification - Ganzer Fall bei Radiopaedia
Pancreatic
calcifications • Chronic pancreatitis - Ganzer Fall bei Radiopaedia
Renal
osteodystrophy • Secondary hyperparathyroidism - Ganzer Fall bei Radiopaedia
Pancreatic
calcifications • Colon cancer with calcified liver metastasis - Ganzer Fall bei Radiopaedia
Pancreatic calcifications can arise from many etiologies.
Punctate intraductal calcifications
- chronic pancreatitis
- alcoholic pancreatitis (20-40%)
- intraductal, numerous, small, irregular
- preponderant cause of diffuse pancreatic intraductal calcification
- gallstone pancreatitis (2%)
- much less commonly associated with calcifications
- hyperparathyroidism (10%)
- most also have nephrocalcinosis or urolithiasis (70%)
- alcoholic pancreatitis (20-40%)
- kwashiorkor
- calcifications are common
- manifest in the pediatric population
- hemochromatosis
- idiopathic: no underlying cause can be determined
Smaller intraductal calcifications
- senile
- usually in patients aged over 70 years
- scattered
- number of calcifications increase with age
- cystic fibrosis: finely granular calcifications in smallest ducts in end stage disease with pancreatic failure
- atherosclerotic calcifications
- chronic pancreatitis
Larger intraductal calcifications
- hereditary pancreatitis
- autosomal dominant 9% penetrance
- large rounded shape
- peaks at 5-17 years
- chronic pancreatitis
- gallstone migration
- tropical pancreatitis: young patients in tropical countries
Dystrophic calcification
- old insult
- old infection
- old infarction
- old trauma
- pancreatic tumors
- islet cell tumors: especially non-functional tumors; 20% islet cell tumors
- calcified metastasis
- colon
- renal
- cystic pancreatic neoplasms
- mucinous (macrocystic) cystadenomas and carcinomas: mucus in tumor rarely calcifies; cysts >2 cm
- serous (microcystic) cystadenomas and carcinomas: commonly calcify, characteristically as a central calcified scar with radiating calcified septations
- intraductal papillary mucinous neoplasms: widened pancreatic duct extensive mucus
- solid and pseudopapillary epithelial neoplasm
- rare: in young women. commonly calcifies. characteristically punctate, peripheral calcifications.
- pancreatoblastoma: rare. ~ 20% calcify
- cavernous lymphangioma / hemangioma (multiple phleboliths)
Note: adenocarcinomas of the pancreas do not generally calcify; rather, they typically engulf previously present adjacent calcifications.
Pancreatic calcification mimics
- atherosclerosis of splenic artery and intrapancreatic arterioles
- oral contrast in duodenal diverticula
Siehe auch:
- zystische Fibrose
- Chronische Pankreatitis
- Insulinom
- solider pseudopapillärer Tumor des Pankreas
- intraduktale papillär muzinöse Neoplasie
- Verkalkungen Arteria lienalis
- Pankreatoblastom
und weiter:
Assoziationen und Differentialdiagnosen zu Pankreasverkalkungen:
