Pancreatic Calcifications and Calcified Pancreatic Masses: Pattern Recognition Approach on CT

Abstract

Pancreatic calcifications are being detected more frequently because of the widespread use of imaging, particularly CT. Pancreatic calcifications are most commonly associated with chronic pancreatitis related to alcohol abuse. Several other pathologic entities, however, can cause pancreatic calcifications. Familiarity with these entities and their CT appearance is helpful in making an accurate diagnosis.

An Atypical Presentation of Pancreatic Pseudocyst Masquerading as Solid Pseudopapillary Neoplasm of Pancreas

“…Pancreatic pseudocyst usually occurs as a sequela to acute pancreatitis, chronic pancreatitis, or pancreatic trauma [ 18 ]. However, pancreatic pseudocyst can occur as an incidental radiological finding only.…”

“…However, the change in decubitus of the patient confirms the presence of floating debris. Besides, imaging features of acute pancreatitis like the bulky pancreas, peripancreatic fat stranding, interstitial edema, or features of chronic pancreatitis like the atrophic pancreas, dilated pancreatic duct, and intraductal and intraparenchymal calcifications often accompany pancreatic pseudocyst [ 18 ]. In contrast to cystic neoplasm of the pancreas, calcification is extremely rare in pancreatic pseudocyst.…”

Radiological Workup of Cystic Neoplasms of the Pancreas

“…The serous fluid-filled cysts are lined by glycogen-rich epithelial cells and separated by thin, fibrous septa. As the lesion grows, the retraction of fibrous tissue yields a central scar showing coarse calcifications in a stellate pattern in about 20-30% of cases, which is considered as a characteristic feature [23,25,26]. Generally, calcifications are seen in lesions larger than 5 cm [23,25].…”

“…The cyst walls are usually thickened but may be smooth and thin. Peripheral curvilinear or eggshell calcifications may be seen in the wall or internal septa in up to 25% of cases and are better depicted on CT [2,26,30]. MCNs may grow slowly over time, at an average rate of 4 mm per year [33,34].…”

“…Calcification may be seen with any type of IPMN (in about 20% of cases). The less commonly observed coarse calcifications are correlated with malignant degeneration (mostly with concurrent malignant features), whereas the more common punctate calcifications are not [26,40]. Invasive IPMNs may be solid appearing if the cystic component is replaced by tumor.…”