Case 140:   Metastasis - Pancreatic Cancer

Diagnostic Category:

Clinical Presentation:

59 year old man abdominal pain and weight loss.

CT: Hypovascular, with reactive hypervascular THAD.

Imaging Findings:

Multiphase CT shows multiple hypovascular metastases with reactive hypervascular perfusion abnormalities (transient hepatic attenuation differences - THADs). Metastases are largely necrotic and demonstrate an almost uniformly thin hypovascular rim on arterial and portal venous phase, while the hypervascular hepatic parenchymal perfusion abnormalities are of variable thickness and irregular. There is also a subsegmental wedge shaped THAD in segment 8 (5th image arrows).

Hypovascular primary tumor in the pancreatic tail, representing moderately differentiated adenocarcinoma. Hypervascular rim around pancreatic cancer metastases is a commonly seen feature.