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Fig. 7 —65-year-old man with unresectable pancreatic cancer.
Inferiorly positioned pancreatic head and uncinate process cancers are usually
unresectable if they locally invade superior mesenteric vein or transverse
mesocolon. Axial CT image shows small inferior pancreatic head–uncinate
process tumor (solid black arrow) applied over 90° arc to
superior mesenteric vein (black arrowhead). Note jejunal branch
(dashed arrow) entering superior mesenteric vein at this level.
Despite CT findings, surgery was attempted, but adequate vascular control of
superior mesenteric vein could not be performed safely. Palliative surgery was
performed. In addition, transverse mesocolon was invaded. This finding was not
called preoperatively, but, in retrospect, there was wispiness of mesocolic
fat (white arrow). Note proximity of fine veins (white
arrowheads) in mesocolon.
