Male 41 years old with acute pancreatitis on 8/21/16 and s/p EUS on 11/18/16 with heterogenous hyper and hypoechoic foci within enlarged pancreatic head. FNA -prelim with inflammatory process, otherwise normal. MRI/MRCP for further evaluation given persistent abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and smooth in contour. A well-defined, subcentimeter T2 hyperintense nonenhancing lesion in segment 2 of the liver is compatible with a simple cyst. No suspicious liver lesion.Normally distended gallbladder with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation. There is mild narrowing of the common bile duct at the level of the pancreatic head.SPLEEN: No significant abnormality noted.PANCREAS: There is masslike enlargement of the pancreatic head with areas of abnormal low T1 signal and small foci of nonenhancement likely corresponding to areas of necrosis. An additional smaller focus with similar imaging characteristics is seen in the pancreatic tail (series 16, image 42). The body and tail of the pancreas are slightly atrophic. The pancreatic duct is not seen at the level of the pancreatic head, the duct is prominent in the body and tail measuring 3 mm in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral simple renal cysts. No suspicious renal lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Masslike enlargement of the pancreatic head is with areas of necrosis is most suggestive of autoimmune or resolving acute interstitial pancreatitis. A lesion with similar imaging characteristics in the pancreatic tail may be part of the same process. Follow-up MRI in 6-8 weeks is suggested to ensure the process has resolved.