DIFFERENTIAL DIAGNOSIS OF PANCREATIC CALCIFICATION

Roentgenologically demonstrable pancreatic lithiasis may occur in a number of conditions. In this country about 90 per cent of the patients in whom such calcification is shown will have alcoholic pancreatitis. A history of longstanding alcoholism with frequent episodes of severe abdominal pain can usually be obtained from such patients.

Hereditary pancreatitis may be suspected roentgenologically when large, unusually rounded pancreatic calculi are demonstrated. A positive family history is the most important diagnostic element in such cases.

When pancreatic lithiasis occurs in association with nephrocalcinosis, hyperparathyroidism should be suspected and the appropriate chemical studies performed.

A few patients with advanced cystic fibrosis and diabetes mellitus have roentgenologically evident pancreatic calcification.

In underdeveloped nations, pancreatic calcification is frequently observed in association with protein malnutrition; whether such calcification occurs in impoverished sections of the United States is not known.

From 2 to 4 per cent of all American patients with pancreatic calcification have coexisting pancreatic carcinoma; it appears that alcoholism and chronic pancreatitis in some way predispose to development of pancreatic malignancy. When calcification occurs together with pancreatic cancer, it usually indicates pre-existing pancreatitis. Occasionally it is present only proximal to a tumor which has occluded the pancreatic duct and these patients may not have had any previous pancreatitis.

Actual tumor calcification may occur in cystadenoma and cystadenocarcinomas. In some of these cases a radiating spoke-like pattern allows preoperative diagnosis.

Cavernous lymphangioma is another neoplasm in which the pattern of calcification may be characteristic.

In occasional instances pancreatic lithiasis occurs in patients without any clinical evidence of pancreatic disease. Such patients usually have nonspecific pancreatic ductal stenosis with formation of calculi upstream from the site of obstruction.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. J. Lesniak, M. D. Hohenwalter, and A. J. Taylor Spectrum of Causes of Pancreatic Calcifications Am. J. Roentgenol., January 1, 2002; 178(1): 79 - 86. [Full Text] [PDF]