87-year-old woman with history of pancreatic mass on CT. ABDOMEN:LIVER, BILIARY TRACT: Scattered foci of calcification are seen in the liver, otherwise the liver is normal in signal and morphology. The gallbladder appears and there is no intra or extra hepatic biliary ductal dilatation.SPLEEN: The spleen appears normal.PANCREAS: Within the tail of the pancreas (series 3, image 11) there is a lobulated 39 x 32 mm, T2 hyperintense lesion with thin, mildly enhancing septae. The majority of these fluid locules are homogenous in signal intensity on both T2 and T1 sequences and similar in signal intensity to one another on T1 and T2 sequences. There is a similar lesion seen in the neck of the pancreas (series 3, image 8) measuring 14 x 14 mm. Finally, there is a subcentimeter area of T2 hyperintense signal in the body of the pancreas (series 3, image 12). The latter lesions appear to communicate with the pancreatic duct which is nondilated. The larger size of the lesion located in the pancreatic tail makes assessment for a definitive connection to the pancreatic duct difficult. The distal pancreatic parenchyma is normal without atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are noted, the largest of which is a right midpole cyst measuring 47 x 46 mm (series 9, image 9).RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Corresponding to lesion seen on earlier CT is 39 mm lobulated pancreatic tail lesion containing enhancing septations. Additional smaller pancreatic head and body lesions seen that appear to communicate with the pancreatic duct are seen, consistent with sidebranch IPMNs. The larger size of the pancreatic tail lesion makes definitive identification of a pancreatic ductal connection difficult. However, given the lobulated and multicystic appearance of the dominant lesion and the presence of sidebranch IPMNs elsewhere, another sidebranch IPMN is favored. Although the location is atypical, a serous cystic neoplasm is another differential consideration. 