PMC6000739_01
A (left): Contrast-enhanced computed tomography scan (CECT) shows a 1.6 x 1.4 cm fluid collection located at the uncinate process of the pancreas(red arrow). B (right): Contrast-enhanced computed tomography scan (CECT) hypervascularity around tail of the pancreas (red arrow)and a draining vein joint portal vein confluence (green arrow).
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Contrast-enhanced computed tomography scan (CECT) done which shows a 1.6 x 1.4 cm fluid collection was seen in uncinate process of the pancreas (Fig. 1A) which was not found in a previous CT done by other hospital three weeks before. Also, there was hypervascularity around tail of the pancreas with a draining veins noticed to joint portal vein confluence (Fig. 1B).
A (left): Magnetic resonance imaging (MRI) demonstrates a lobulated mass measuring 1.8 x 1.6 cm with gas pocket at the center (red arrow). B (right): Magnetic resonance imaging (MRI) demonstrates an abnormal vasculature involving entire pancreas, as well as the nidus of AVM can be seen (red arrow).
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After three days, magnetic resonance imaging (MRI) done which demonstrates the previously mentioned collection as lobulated mass measuring 1.8 x 1.6 cm with air pocket at the center (Fig. 2A). There were abnormal and extensive arterial and venous vasculature within and surrounding the pancreas were seen with several draining veins to the portal venous system (Fig. 2B).
Computed Tomography Angiogram (CT Angiogram) demonstrates enhancement of portal venous system during arterial face (green arrow), and bazar vasculature as P-AVM involving the entire pancreas;head, body, and tail (red arrows).
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Angiogram (CT Angiogram) done to confirm the diagnosis which demonstrates enhancement of portal venous system during arterial face, and bazar vasculature as P-AVM involving the entire pancreas (Fig. 3). After ten days, a follow up MRI done to follow the mass.
Magnetic resonance imaging (MRI) shows interval increase in size comparing to the previous MRI measuring 2.4 x 2.3 cm with multiple gas pockets in the mass center (red arrow).
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The study shows interval increase in size measuring 2.4 x 2.3 cm with multiple gas pockets in the mass center (Fig. 4).
Dilated pancreatic ducts with parenchymal necrosis around (UP,LEFT). Blood vessels proliferation (UP,RIGHT). Thickened blood vessels with fat necrosis and parenchymal fibrosis (DOWN, LEFT). Parenchymal nicrosis with inflammatory cell infiltrate (DOWN, LEFT).
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Microscopically; there is focal vascular proliferation, pancreatic ducts proliferation, parenchymal nicrosis, fibrosis, with chronic inflammatory cell infiltrate (Fig. 5).