Question: Hi this is in reference to a 65year old female . Her recent abdomen CT shows ------ heterogenous decreased attenuation of the head of pancreas non -specific in apprearance without a discrete cystic or solid mass identified.; The pancreatic duct is not dilated. No pancreatic parenchymal calcifications noted. No peripancreatic inflammatory fat stranding, free fluid, fluid collection or pseudocyst. No intrahepatic or extrahepatic biliary ductal dilation.
Differential diagnosis includes: possible sequela of recent acute pancretitis, or focal fatty infiltration of the pancreas or other etiology.
The patient has no abdominal pain, no other symtoms, even blood work is normal.
is there any reson to worry for these possible findings?
Please advise. Thanks
Mr XXXX
New XXXX

Hi Dr Klerida
thanks for your reply. I am going to exactly type up the report on the CT.
Basically the patient went for a chest xray. they found a incidental nodule which was further evaluated for chest CT which came back normal. But the chest CT showed incidental finding of the head of pancreas. So the GI doctor said to do a abdomen CT. The abdomen CT says the following exactly I am typing for you :

Heterogenous decreased attenuation of the head of pancreas non -specific in apprearance without a discrete cystic or solid mass identified.; The pancreatic duct is not dilated. No pan parenchymal calcifications noted. No peripancreatic inflammatory fat stranding, free fluid, fluid collection or pseudocyst. No intrahepatic or extrahepatic biliary ductal dilation.
Differential diagnosis includes possible sequela of recent acute pancretitis, or focal fatty infiltration of the pancreas or other etiology.
Suggested to do MRI in 6 weeks for any changes or stabilty.

Now, the radiologist gave me the CD of the CT and I took it to Gasentrolonogist . He looked at the CD and said not to worry about cancer and do a MRI after 3 months.He thinks it may be a fat.
Now, just for a second opinion i took the CT report to another Gasentrologist. His office dont have acces to see the CD of the CT. But based on the report he wants to do an EUS (endoscopic ultrasound) and a possible biopsy.

So we are very confused with all these tests . You think they are experimenting too much? I mean the CT clearly dont say any mass or cyst. So am kind of happy with the first GI doctor suggestion. But you think the second GI doctor may do unnecessary biopsy during EUS and hurt the pancreas? The patient just did a endoscopy last week and another EUS next week. Is it harmful to do these 2 test in a week?

I also think its a benign condition. All these incidental findings are making the patient more sick. Do you think there is any sign of cancer here in the report?
ANY OTHER ADVICE?

Thanks much
Mr XXXX
New XXXX

Hello again Dr Klerida,
you are simply awesome. I have read the worried patient what you wrote and she is little calm now . Thanks to you.
One more question, see I cannot avoid now the EUS procedure as because i dont want to make the second doctor upset as she is in network of the patient's health insurance company.
My question is , if it is a fatty concentration, why she wants to do posible biopsy? You know when doctor use this term, we think, may be she is looking for cancer?
but is it also possible that biopsy is also to see what these fatty things are?

Also. madam, what is the process of treating these fats in pancreas? can these fats turn into pancreatic cancer in future?


Please advise
and thanks soooo much again
Mr XXXX