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Sixty-nine met inclusion criteria of having been performed for focal enlargement or fullness of the pancreas.
Ultrasound and MRI demonstrate focal enlargement of the muscle, with typical sparing of the internal muscle fibres [50, 52].
EUS should be strongly considered as the next step in the evaluation of patients with focal enlargement of the pancreas when clinical suspicion of malignancy exists.
On chest X-ray, azygos continuation can be suspected in the presence of a focal enlargement of the right paratracheal stripe above the right mainstem bronchus.
The pancreas shows diffuse or focal enlargement with irregular narrowing and loss of the pancreatic cleft and smooth rim (capsule-like rim).
The detection of a focal enlargement or distortion of the normal contour of the pancreas is a common finding for radiologists who treat pancreatic diseases.
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Patients with such focal enlargements of the pancreas will have a conventional pancreatic carcinoma (PC) even if pathognomonic features of pancreatic carcinomas are still lacking, while a small percentage of them may have an inflammatory pancreatic mass (IPM).
Contrast-enhanced CT (CECT) is an important modality in the evaluation of AIP, and may clearly demonstrate classical features such as diffuse or focal pancreatic enlargement.
MRI imaging of AIP (Figs. 3 and 4) demonstrates the same gross morphological features as CT; diffuse or focal pancreatic enlargement with loss of normal pancreatic lobulations.
Both conditions may produce focal pancreatic enlargement, hypoenhancing lesions with mass effect (Fig. 1), dilatation of the pancreatic and common bile ducts, duct strictures and increased density in the peripancreatic fat [1, 2, 3].
The pathology involves diffuse or focal organ enlargement and mass-forming or thickening lesions, caused by heavy infiltration of IgG4-positive plasma cells and lymphocytes with fibrosis [10 12], in various organs, with resultant autoimmune pancreatitis, sclerosing cholangitis, cholecystitis, sialadenitis, retroperitoneal fibrosis, inflammatory aortic aneurysm, or inflammatory pseudotumors.
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