The answer
If you studied the scan methodically you would see something abnormal
Note that the head of the pancreas appears to be larger than usual. This is the
reason that the superior mesenteric vessels appeard so far away from the aorta.
There is fat stranding around the pancreas best seen stretching from the
pancreas between the inferior vena cava and the liver, anterior to the right
renal vein, this continues into the fat between the liver and right kidney.
There is a lucency in the head of the pancreas anterior to the vena cava and
medial to the duodenum, this is probably an enlarged bile duct. The enlarged
bile duct could indicate distal obstrution, perhaps due to a gall stone or
pressure from the swollen pancreas.
Signs of severe pancreatits would be lack of consistant enhancement and areas
that do not enhance suggest ischemia and necrosis. Other worrysome features
would be gas flecks in the pancreas. Ascitis is common in pancreatits.
A word of warning,
Do not mistake the third part of the duodenum/proximal
jejeunum for the body or tail of the pancreas. In this image the third part of
the duodenum/proximal jejeunum has small flecks of gas in it and could be
mistaken for gas in the pancreas, however, note the obvious intestinal folds
demarcated by the oral contrast.
After careful consideration you could say;
The head of the pancreas appears enlarged and there is fat stranding best
seen in the retroperitoneum in relation to the head of the pancreas and
extending into the fat between the inferior vena cava and liver and here
(pointing) between the right kidney and liver.
There is a lucency in the head of the pancreas just medial to the duodenum
which may represent a dilated common bile duct.
I dont see evidence of ascitis, or lack of enhancement in the head of the
pancreas, there is no focal fluid collection or free gas seen.
The patient most likely has pancreatits, the enlarged bile duct raises the
possibility of this being related to gallstones.
