MENG Ting, YUAN Zhibing, XU Maoli, et al
Journal of Clinical Radiology.
2023, 42(11):
1774-1779.
Objective To analyze the clinical features,CT features and causes of misdiagnosis of ectopic pancreas (EP),and to improve the understanding and diagnostic accuracy. Methods The clinical data of 117 EP patients and CT data of 45 EP patients were retrospectively analyzed. Results (1)Clinical manifestations:The most common symptoms were abdominal distension and abdominal pain(64.6%),and a few of them had abdominal discomfort,acid regurgitation,belching,nausea,vomiting,jaundice,melena and other symptoms. Intussusception and intestinal obstruction were easy to occur in children,and 16.7% had no symptoms.(2)Location:Among 117 cases,60 cases (51.3%)occurred in stomach,26 cases(22.2%) in duodenum,19 cases(16.2%) in empty ileum,2 cases in esophagus,2 cases in mesentery,2 cases in bile duct,1 case of esophageal diverticulum,1 case of ileum and ileocecal diverticulum,1 case of colon and 1 case of gallbladder,and 1 case of bile duct and duodenum simultaneously.(3)CT features:47 lesions were found in 45 patients,43 were single lesions,and 45 lesions had clear boundary.45 were solid and 2 were cystic. Most of them (82.9%) showed oval or flat shape and round shape,while a few showed irregular shape and local gastric wall/intestinal wall thickening.73.9% were intraluminal growth,21.7% were both intraluminal and extraluminal growth,and 4.4% were extraluminal growth. Catheter sign was observed in 6 lesions and umbilical concave sign in 3 lesions. The long diameter/short diameter of the lesions ranged from 1.00-2.28,with an average of (1.52±0.41),and (92.7%) the length diameter of the lesions was less than 3cm.The EP on CT plain scan was uniform and isodense,and the enhancement degree of portal phase and delayed phase (37/41) was similar or higher than that of the original pancreas. There were significant differences in the CT values between the two groups (P< 0.05).There was no significant difference in the CT values between the two groups in portal phase and delayed phase. EP was significantly correlated with CT values of simultaneous in-situ pancreatic CT,arterial phase,portal phase and delayed phase (r=0.600,0.502,0.697,0.792,P< 0.05).Of the 47 lesions,4 were correctly diagnosed,30 were misdiagnosed,3 were missed,and 10 were undiagnosed. Conclusion The CT features of ectopic pancreas have certain characteristics. It is helpful to the diagnosis of ectopic pancreas by combining the location,growth mode,long diameter/short diameter value,density and enhancement mode,catheter sign and umbilical concave sign. The main reasons for missed diagnosis and misdiagnosis are non-specific clinical manifestations,insufficient understanding and insufficient preparation before examination.