What does my CT scan report indicate?

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Posted on Thu, 11 Jun 2015 in Digestion and Bowels
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
doctor
Answered by Dr. Klerida Shehu 10 hours later
Brief Answer:
Following information is required...

Detailed Answer:
Hi Mr. XXXXXXX

I understand your concerns. Before running into final conclusions, I'd like to have a look at the ct-scan report myself to analyze the changes better.

1. If such changes in the pancreas without changes in the pancreatic ductus are suggestive for benign pathologies, as already mentioned in the report: focal fatty infiltration of the pancreas.

2. If the doctor who performed ct-scan was not sure about the findings, would have asked to run MRI which can give better and different images from ct-scan and would help determine the final diagnosis.

3. What puts me on thought is : why the doctor has asked ct-scan if the patient has no abdominal pain, no other symptoms with normal blood work? More information regarding this patient medical history and clinical presentation is required.

Thank you!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu 38 minutes later
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
doctor
Answered by Dr. Klerida Shehu 52 minutes later
Brief Answer:
I agree to run MRI after 3 months...

Detailed Answer:
Hi back XXXXXXX

Thank you for typing the ct-scan report.

1. I was going through the typed report you sent in and once again, I can say that the heterogenous decreased attenuation of the head of pancreas might be a benign finding, most probably fatty infiltration.

2. As mentioned earlier, I totally agree with MRI testing after 3 months to evaluate the findings of Ct-scan.

3. EUS is a great diagnostic choice while biopsy remains the golden standard test to determine the nature of lesions.

However, in the case of this patient, I do not see any indication to run such tests because:
- ct-scan findings were occasional
- the patient is having no abdominal/digestive problem
- no lesion was found during ct-scan testing: no solid neither cystic lesion

Therefore, I do not think these tests to be run in the case of this patient.

Meanwhile, I totally agree with MRI testing.
4. I also advise to calm the patient down as nothing worrisome is happening. She should continue her life peacefully as she was doing until now.

5. With regards to running a second endoscopic examination within a short period of time, that is not a problem for the patient.
Regarding the side effects of biopsy, it is run through FNA(fine needle aspiration), with a fine needle with very very little chances for bleeding or other complications.

Hope it answered to your queries and cleared your doubts!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu 2 hours later
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
doctor
Answered by Dr. Klerida Shehu 17 hours later
Brief Answer:
Please follow the suggestions below,,,

Detailed Answer:
Hi back Mr.XXXX,

Thank you for providing additional information.

1. The golden standard to determine the final diagnosis is FNA.

2. With regards to biopsy, it will help determine if there are inflammatory processes present. Cancer is not the only one diagnosis to think over . Chronic pancratitis is to be excluded too.

3. Her symptoms and overall health situation are not showing any risk for cancer neither pancreas cancer.
Instead, they might be suggestive or put her at high risk for pancreatitis.

4. With regards to treatment, it will include following a healthy diet with restriction in fatty foods.

5. These fatty infiltrations will not turn to cancer. The only high risk is for pancreatitis.

Usually, such fatty changes are associated with hyperlipedemia. Once they are completely treated, subsequently there will be improvement in pancreas changes.

Hope it was of help!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2265 Questions

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