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| Clinical characteristics and imaging misdiagnosis analysis of duodenal heterotopic pancreas |
| XIA Zhen-yuan, LI Wei-xiong, HE Hua, DONG Xin |
| Department of Radiology, the Second Affiliated Hospital, Guangxi Medical University, Nanning 530000, China |
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Abstract Objective: To analyze the clinical characteristics and CT findings of heterotopic pancreas in duodenum. Methods: The clinical and imaging data of 10 patients with heterotopic pancreas in duodenum were reviewed retrospectively,which were confirmed by pathology but misdiagnosed by imaging. Clinical manifestations, morphological characteristics, the ratio range between longitudinal diameter(LD) and short diameter(SD) and the differences in CT values between normal pancreas and the lesions were analyzed. Results: Main clinical manifestations in these patients were as follows: recurrent abdominal pain and distension in 5 cases, melena in 3 cases and jaundice in 2 cases. In terms of imaging findings, two lesions were not shown on CT which were located in duodenal papilla or Vater ampulla, and eight cases showed nodular lesions which were all above Vater ampulla. Six cases were Yamada type Ⅱ, seven cases were intracavitary, five cases showed clear margin and homogeneous density. The LD/SD values in eight cases were from 1.14 to 1.92, which was 1.52±0.24 in an average, LD/SD were above 1.4 in 5 cases. In the plain phase and the portal vein phase, CT values of the lesions were slightly lower than normal pancreas(t=-3.41, -1.00, P＜0.05), the mean differences were only (6.38±2.45) HU and (5.25±3.33) HU respectively, which were indistinguishable to naked eyes. In the aspect of misdiagnoses, four cases were misdiagnosed as leiomyomas or inflammatory polyps, four cases as gastrointestinal stromal tumors(GIST), two cases as periampullary carcinomas. Conclusion: The imaging findings of heterotopic pancreas in duodenum are nodules with broad base, intracavitary distribution, clear margin, homogeneous density and the similar characteristics of enhancement to normal pancreas. However, atypical imaging findings may lead to misdiagnosis. Further understanding of the disease as well as fully combining with clinical features are of vital importance for diagnosis.
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Received: 24 October 2016
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