Prominent Tail of Pancreas on CT and Ultrasound

[Aorist]

I am an extremely healthy 43 year old white woman who has been experiencing upper abdominal pain (pressure) with inconsistent bowel habits for several months now (no blood).  I have also lost about eight pounds - more out of a loss of appetite and a desire to keep my bowels calm.  

Spiral CT of the abdomen and pelvis indicates all is normal, with the following exception - "tail of the pancreas is prominent. There is no evidence of pathology, however. There is no evidence of a mass in the tail of the pancreas. This could be followed up with an ultrasound of the pancreas."

IMPRESSION: 1. Prominent tail of the pancreas. Although pathology is not suggested, ultrasound of the tail of pancreas might be considered.  

Subsequent ultrasound findings state, "This examination is to evaluate echotexture of the pancreas.  Multiple real-time transverse and longitudinal sections were obtained through the pancreas.  The tail is mildly prominent measuring 22 mm in maximal dimension versus 15 in the region of the head.  Echotexture is homogeneous and no discreet mass or pseudocyst is suggested. There is no peripancreatic fluid identified. The pancreatic duct is not ectatic.  No internal pacreatic calcifications are appreciated."  

IMPRESSION: Mild prominence of the pacreatic tail, felt to reflect a normal variant given homogeneous echotexture. No further work up suggested at this time.  

I have also had blood work which reveals nothing abnormal and a HIDA scan which shows a normally functioning gall bladder. My doctor seems to want to follow up with a GI series.  

What possible explanations are there for an enlarged pancreatic tail, given these findings?  Congenital abnormality?  (I do not drink or use drugs.) Are there any secondary conditions related to an enlarged pancreas?  Should I be concerned about this at all?  What followup would you recommend?  

[Kevin Pho, MD]

With the impression of the ultrasound, it is less likely that cancer is present.  Pancreatitis can also cause inflammation of the pancreatic tail - which can be evaluated with amylase and lipase levels.  It is more likely a normal (or congenital) variant is present.  The radiologist seems pretty confident that no further pancreatic workup is needed and I would see no reason to disagree with the impression.

As for tests to evaluate the discomfort, I would suggest either an upper GI series or upper endoscopy to evaluate for inflammation, GERD, or an ulcer which may be causing the symptoms.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[paty91356]

Hi, and welcome to the world of mysterious conditions of the pancreas...
In my situation, it is the head of the pancreas that shows up as "enlarged"...this was first discovered over 20 years ago when I had some tests for upper left quadrant pain and other GI symptoms.  I had it thoroughly investigated then, and it disappeared for about 15 years.  In the past 5 years, the discomfort has re-appeared, and sometimes my pancreatic enzymes are elevated, and I feel lousy.  Again...I have had colonoscopy, ERPC (EPRC?), esophogoscopy, cat scan (with and without contrast dye), and ultrasound...they all show the enlargement, but nothing more.  I've about decided it is a congenital enlargement, but I think I also have Sphincter of Oddi dysfunction....
This is just to reassure you that enlargements can be present without any pathology...
Good luck!
Pat

[atitparsai]

A related discussion, Pancrease Tail was started.