Case 6

This is a CT study of the chest, abdomen and pelvis, showing an ill-defined, hypo-enhancing lesion in the head and uncinate process of the pancreas; this is causing extra and intra-hepatic bile duct as well as main pancreatic duct dilatation and subsequent thinning of the pancreatic parenchyma. There is a metallic clip placed in the second part of the duodenum, likely by endoscopy. I cannot appreciate any liver metastatic lesions.

The findings represent a likely malignant mass in the head of the pancreas / ampulla causing pancreatic and biliary ductal obstruction. This is most likely an adenocarcinoma of the pancreas.

In the first instance, I would alert the referring physician and recommend endoscopy with EUS for tissue biopsy / FNAC, as well as to place a biliary stent endoscopically in order to relieve the obstruction.

I would also recommend that the case be discussed at hepatobiliary MDT, with a view to surgical management by Whipple’s procedure.