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RADIOLOGY: ABDOMEN: Case# 32823: CHRONIC PANCREATITIS W/SPLENIC V. THROMBOSIS AND GASTRIC VARICES. This is a 54-year-old white male with a history of gastric varices who presented with upper GI bleeding. The liver is normal in appearance without focal lesions evident. Gastric varices are identified. The spleen is mildly enlarged with thrombosis of the splenic vein evident. Changes consistent with chronic calcific pancreatitis are also identified with a possible small, approximately 1 cm pseudocyst near the tail of the pancreas. Chronic pancreatitis is now believed by many not to be merely the sequelae of repeated bouts of acute pancreatitis, but rather a separate disease entity with its own natural history. Chronic pancreatitis is usually due to related to long-term alcohol abuse. Other etiologies include hyperlipidemia, hyperparathyroidism, cholelithiasis and cystic fibrosis. In addition, a form of autosomal dominant familial pancreatitis known as hereditary pancreatitis can result in chronic calcific pancreatitis. CT findings in chronic pancreatitis include main pancreatic duct dilatation (66%), parenchymal atrophy (54%), calcifications (50%), pseudocysts (34%), focal gland enlargement (32%), biliary ductal dilatation (29%), and pancreatic fat/fascia abnormalities (16%). The pancreas may appear normal in 7% of cases. Irregular pancreatic duct dilatation with a duct width to total gland width ratio of less than 0.5 favors chronic pancreatitis. Smooth or beaded pancreatic ductal dilatation is associated with carcinoma.

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