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Pancreatic Calcification

Pancreatic calcifications can arise form many aetiologies.

Punctate intraductal calcifications

  • acute alcoholic pancreatitis (20-40%)
    • intraductal, numerous, small, irregular
    • preponderant cause of diffuse pancreatic intraductal calcification
  • chronic pancreatitis
  • idiopathic: no underlying cause can be determined
  • hyperparathyroidism (10%) – look for nephrocalcinosis or urolithiasis (70%)
  • Kwashiorkor
    • calcifications are common
    • seen in paediatric population

 

Smaller intraductal calcifications

  • senile
    • usually over 70 years
    • scattered.
    • calcifications increase with age
  • cystic fibrosis: finely granular calcifications in smallest ducts in end stage disease with pancreatic failure
  • atherosclerotic calcifications
  • chronic pancreatitis

Larger intraductal calcifications

  • hereditary pancreatitis
    • autosomal dominant 9% penetrance
    • large rounded shape
    • peaks at 5-17 years
  • chronic pancreatitis
  • gallstone migration
  • tropical pancreatitis: young persons in tropical countries

Dystrophic calcification

  • old insult
    • old infection
    • old infarction
    • old trauma
  • pancreatic tumours
    • islet cell tumours: especially non-functional tumours; 20% islet cell tumours
    • calcified metastasis
      • colon
      • renal
    • cystic pancreatic neoplasms
      • mucinous (macrocystic) cystadenomas and carcinomas: mucus in tumour rarely calcifies; cysts >2 cm
      • serous (microcystic) cystadenomas and carcinomas: commonly calcify, characteristically as a central calcified scar with radiating calcified septations
      • intraductal papillary mucinous neoplasms: widened pancreatic duct extensive mucus
      • solid and pseudopapillary epithelial neoplasm
        • rare: in young women. commonly calcifies.  characteristically punctate, peripheral calcifications.
      • pancreatoblastoma: rare. ~ 20% calcify

 

Note: adenocarcinomas of the pancreas do not generally calcify; rather, they typically engulf previously present adjacent calcifications.

 

Pancreatic calcification mimics

  • atherosclerosis of splenic artery and intrapancreatic arterioles
  • oral contrast in pancreatic diverticula

 

Tagged as:

Categorised in: Gantrointestinal, Medicine, Surgery

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