Pankreatik kanal taşı ve obstrüksiyonu

Özet

Ana pankreatik kanal taşı en sık kronik pankreatit zemininde gelişir ve kanal akımını bozarak tekrarlayan ağrı ya da pankreatit ataklarına eşlik edebilir. Kontrastsız BT, kalsifiye taşları ve bez içindeki kalsifikasyon dağılımını göstermede kullanışlıdır; kanalın genişleme ve darlıklarını ince kesitlerde izlemek gerekir. Taşın bulunduğu yerdeki obstrüksiyon, yukarı akım kanal genişlemesi ve bez atrofisi ile birlikte okunur. Kanaldaki ani geçişler yalnızca taşa bağlanmamalı; taş ile açıklanamayan fokal obstrüksiyonlarda altta yatan duktal tümör araştırılmalıdır.

Faz ve pencere

Kontrastsız tanısal

Kanal lümeninde yüksek atenüasyonlu, noktasal ya da kaba kalsifik odak ve bez içi parankimal kalsifikasyonlar seçilebilir; ince kesitlerde odağın ana kanal seyriyle aynı hatta olup olmadığını doğrula. Bu faz taşın kalsifik yapısını ve dağılımını gösterir, eşlik eden yumuşak doku kitlesini dışlamaz.

Portal

Kontrastlı portal venöz görüntülerde obstrüksiyonun proksimalindeki kanal genişlemesi, bez hacim kaybı ve kalsifikasyonun çevresindeki hipoenhans kitle araştırılır; kronik pankreatitte fibrotik parankim heterojen olabilir. Kitle şüphesi varsa pankreas protokolü ince kesitleriyle değerlendirme gerekir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Ana kanal hattında lümen içi kalsifik odak, komşu damar kalsifikasyonundan ayrı olarak kanalın uzunlamasına seyriyle eşleşir.
• Taşın proksimalindeki ana kanal segmenti genişleyebilir; darlık ve genişleme alanları ardışık kesitlerde değişken kalibre oluşturabilir.
• Kronik obstrüksiyonda pankreas gövde-kuyruk parankimi incelmiş, konturu düzensiz ve lobülasyonu azalmış olabilir.
• Kanal çevresinde ve bez içinde dağınık kaba kalsifikasyonlar kronik pankreatit örüntüsünü destekler.
• Tek, keskin kanal geçişi çevresinde fokal yumuşak doku kalınlaşması veya kontur kabarıklığı varsa taş dışında duktal kitle aranır.
• Pankreas başındaki obstrüksiyonla birlikte koledok genişlemesi görülebilir; iki kanalın ampulla çevresindeki devamı izlenir.

Normalde

Normal incelemede ana pankreatik kanal baş, gövde ve kuyruk boyunca ince, düzenli kalibreli bir çizgi olarak izlenir; bez parankiminde kaba kalsifik odak bulunmaz. Taş şüphesinde aynı düzeyde lümen içi kalsifik odağın kanal ile aynı hatta olup olmadığına, ardından kanalın yukarı akım çapına ve o bölgedeki parankim kalınlığına bakılır.

Ayırıcı tanı

Pankreatik parankimal kalsifikasyon

odak kanal lümeninde değil, bez dokusu içinde veya kanal dışındadır.

PDAC

kanal geçişinde hipoenhans yumuşak doku, kontur bozulması veya çift kanal genişlemesi eşlik edebilir.

Kronik pankreatite bağlı duktal protein tıkacı

kanal genişlemesi yapabilir ancak BT'de kalsifiye taş gibi belirgin yoğunluk göstermeyebilir.

Tuzaklar

• BT’de kronik pankreatit değerlendirilirken pankreas kalsifikasyonları, kanal genişlemesi ve atrofi birlikte dikkate alınmalıdır.
• Kronik pankreatit kalsifikasyonları kanal taşına eşlik edebilir; tüm bezdeki dağılımı incelemeden tek odağı obstrüksiyonun tek nedeni sayma.
• Kalsifiye taş, çevresindeki küçük izodens PDAC odağını görünmez kılabilir; kanalın ani kesildiği kesitlerde parankim kontrastlanmasını ayrıca tara.

Kendini dene

1. Kontrastsız BT'de kanal ekseninde kalsifik odak ve kuyruk yönünde genişleme var. En olası açıklama nedir?

   • Pankreatik kanal taşı
   • Splenik arter anevrizması
   • Seröz kistadenom
   • Safra kesesi taşı
   Cevabı göster

   Pankreatik kanal taşı. Kanal seyriyle aynı hatta bulunan kalsifik odak ve proksimal kanal genişlemesi obstrüktif duktal taşı destekler. Anevrizma damar lümeniyle devam eder; kistadenom kistik kitle, safra taşı ise safra yolları veya kesede yerleşir.

2. Kanalın aniden kesildiği düzeyde fokal hipoenhans doku da görülüyor. Hangi eşlikçi tanı dışlanmalıdır?

   • Duktal adenokarsinom
   • Pankreatik psödokist
   • Dalak enfarktı
   • Duodenal divertikül
   Cevabı göster

   Duktal adenokarsinom. Ani kanal geçişiyle aynı noktadaki hipoenhans doku obstrüksiyon yapan pankreatik kitleyi düşündürür. Psödokist sıvı dansitesinde kapsüllü koleksiyondur; dalak enfarktı dalak parankiminde, divertikül ise duodenum lümeniyle ilişkili bulunur.

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Staged management of a giant adult Todani type IVa choledochal cyst mimicking gallbladder hydropspmc.ncbi.nlm.nih.gov
2. A Pancreas Out of Place: Acute Interstitial Pancreatitis Caused by Pancreatic Herniation in a Type IV Paraesophageal Herniapmc.ncbi.nlm.nih.gov
3. Clinical Characteristics, ERCP Management, and Early Adverse Events Among Patients with Choledocholithiasis at a Romanian Tertiary Referral Center: A Retrospective Cohortpmc.ncbi.nlm.nih.gov
4. Acute Emergent Biliary Pathologies Identified Using Point-of-Care Ultrasoundpmc.ncbi.nlm.nih.gov
5. BILIARY SLUDGE-ASSOCIATED ACUTE PANCREATITIS: CLINICAL SPECTRUM, DIAGNOSIS, AND MANAGEMENTpmc.ncbi.nlm.nih.gov
6. Diagnosis and Management of Chronic Pancreatitis: A Review.pubmed.ncbi.nlm.nih.gov
7. Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature.pubmed.ncbi.nlm.nih.gov
8. Current advances in the management of chronic pancreatitis.pubmed.ncbi.nlm.nih.gov
9. IgG4-related disease coexisting with autoimmune haemolytic anaemia.pubmed.ncbi.nlm.nih.gov
10. Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
11. Asian chronic pancreatitis: the common and the unique.pubmed.ncbi.nlm.nih.gov
12. Pre-ERCP imaging of the bile duct and gallbladder.pubmed.ncbi.nlm.nih.gov
13. Laparoscopic Puestow: lateral pancreaticojejunostomy.pubmed.ncbi.nlm.nih.gov
14. Mirizzi syndrome with endoscopic ultrasound image.pubmed.ncbi.nlm.nih.gov
15. Pancreatic stones treated via an EUS-guided pancreaticogastrostomy with a fully-covered self-expandable metal stent.pubmed.ncbi.nlm.nih.gov
16. Obstructive jaundice due to a rare periampullary tumor.pubmed.ncbi.nlm.nih.gov
17. Computed tomography based scoring system in a prospectively ascertained cohort of patients with chronic pancreatitis.pubmed.ncbi.nlm.nih.gov
18. Portal hypertensive biliopathy: A single center experience and literature review.pubmed.ncbi.nlm.nih.gov
19. A unusual case of multifocal pyogenic abscess formation following ERCP procedure.pubmed.ncbi.nlm.nih.gov
20. Risk Analysis of Pancreatitis With Pancreatolithiasis in Relation to Dyslipidemia as a Cofactor.pubmed.ncbi.nlm.nih.gov
21. Pancreatopleural Fistula Presenting as Recurrent Right-Sided Pleural Effusion: A Case Report.pubmed.ncbi.nlm.nih.gov
22. Artificial Intelligence-Based Prediction of Pancreatic Stone Clearance in Pancreatolithiasis Using Pretreatment CT Images and Clinical Features.pubmed.ncbi.nlm.nih.gov
23. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
24. Pancreatic Calculi: Two Case Reports and Literature Review.pubmed.ncbi.nlm.nih.gov
25. Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas: History, Myths, and Realities Between Past and Future.pubmed.ncbi.nlm.nih.gov
26. Focal Pancreatic Parenchymal Atrophy in Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas.pubmed.ncbi.nlm.nih.gov
27. A Case of Focal Liver Necrosis Following Whipple's Procedure: Presentation, Workup, and Management.pubmed.ncbi.nlm.nih.gov
28. A scoring model for preoperative differentiation of high-enhancement pancreatic ductal adenocarcinoma from mass-forming chronic pancreatitis.pubmed.ncbi.nlm.nih.gov
29. The Differential Diagnosis and Management of Pancreatic Cystic Neoplasms.pubmed.ncbi.nlm.nih.gov
30. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications.pubmed.ncbi.nlm.nih.gov
31. Value and Accuracy of Multidetector Computed Tomography in Obstructive Jaundice.pubmed.ncbi.nlm.nih.gov
32. Perioperative characteristics, histologic diagnosis, complications, and outcomes of dogs undergoing percutaneous drainage, sclerotherapy or surgical management of intrarenal cystic lesions: 18 dogs (2004-2021).pubmed.ncbi.nlm.nih.gov
33. Improvement in the Image Quality of Bile and Pancreatic Ducts with Dual- Layer Spectral CT.pubmed.ncbi.nlm.nih.gov
34. Surgical management strategies and postoperative outcomes of choledochal cysts in children: the role of preoperative radiological assessment in a retrospective observational study.pubmed.ncbi.nlm.nih.gov
35. Giant Asymptomatic Submandibular Sialolith: A Case Report Accompanied by Systematic Review.pubmed.ncbi.nlm.nih.gov
36. Adult Hepatic Infarction for Internists: A Practical Diagnostic and Management Pathway to Avoid Misdiagnosis, Unnecessary Drainage, and Delayed Vascular Recognition.pubmed.ncbi.nlm.nih.gov
37. An update on pancreatic cancer imaging, staging, and use of the PACT-UK radiology template pre- and post-neoadjuvant treatment.pubmed.ncbi.nlm.nih.gov
38. Bridging Imaging and Pathohistology in Pancreatic Hamartoma: A Systematic Review of the Literature with an Integrated Case Report.pubmed.ncbi.nlm.nih.gov
39. Congenital pulmonary airway malformation mimicking lung cancer in adults: a pitfall in oncologic diagnosis.pubmed.ncbi.nlm.nih.gov
40. Beyond the Expected: A Case-Based Exploration and Literature Review on the Rare Evolution of Pseudomyxoma Peritonei From a Side-Branch Intraductal Papillary Mucinous Neoplasm.pubmed.ncbi.nlm.nih.gov
41. Clinical features and outcomes of adult primary retroperitoneal lymphangioma: insights from a high-volume sarcoma center.pubmed.ncbi.nlm.nih.gov
42. Medical hyperspectral imaging: an updated review of technology advancements and biomedical applications.pubmed.ncbi.nlm.nih.gov
43. The SLC-ome of membrane transport: From molecular discovery to physiology and clinical applications.pubmed.ncbi.nlm.nih.gov
44. Mathematical models of cystic fibrosis as a systemic disease.pubmed.ncbi.nlm.nih.gov
45. Common Bile Duct Access After Bariatric Surgery: A Narrative Review of Endoscopic Considerations for Treatment of Choledocholithiasis.pubmed.ncbi.nlm.nih.gov
46. High-Frequency Miniprobe Endoscopic Ultrasonography Across the Gastrointestinal Tract.pubmed.ncbi.nlm.nih.gov
47. Prevention and Management of Endoscopic Retrograde Cholangiopancreatography-Related Perforation: A Guideline-Based Narrative Review.pubmed.ncbi.nlm.nih.gov
48. Pancreatic head resection alongside side-to-side pancreatic duct-jejunostomy for pancreatic stones: A case report and review of literature.pubmed.ncbi.nlm.nih.gov
49. Common cystic pancreatic neoplasms: A comprehensive magnetic resonance imaging-based review of typical and atypical imaging features.pubmed.ncbi.nlm.nih.gov
50. When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
51. Case Report: A rare case of IgG4-related disease initially manifesting with diarrhea and jaundice.pubmed.ncbi.nlm.nih.gov
52. Case report and literature review of IgG4-related autoimmune pancreatitis secondary to pancreatic involvement of IgG4-related sclerosing disease.pubmed.ncbi.nlm.nih.gov
53. Multiple Incidental Pancreatic Neuroendocrine Tumors in a Patient With Suspected Duodenal Papillary Adenocarcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
54. Synchronous medullary carcinoma of the pancreas and non-ampullary duodenal adenocarcinoma.pubmed.ncbi.nlm.nih.gov
55. Not All Painless Jaundice in the Elderly Is Primary Pancreatic Cancer.pubmed.ncbi.nlm.nih.gov
56. Prolonged Retention of a Spontaneously Dislodging Pancreatic Duct Stent in a Patient with Surgically Altered Anatomy: A Case Report.pubmed.ncbi.nlm.nih.gov
57. Beyond the Six-Week Rule: Contemporary Insights Into Pancreatic Pseudocyst.pubmed.ncbi.nlm.nih.gov
58. Special Issue: EACR 2026 Congress: Innovative Cancer Science, 8-11 June 2026.pubmed.ncbi.nlm.nih.gov
59. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
60. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
61. Virtual non-contrast images from dual-layer spectral CT: comparison with true non-contrast across abdominal structures.pubmed.ncbi.nlm.nih.gov
62. Histopathological effect of hypervitaminosis D₃ on the submandibular salivary gland of albino rats and the possible protective role of vitamin K "histological & ultrastructural study".pubmed.ncbi.nlm.nih.gov
63. Big data analytics for CLEC5A dynamics based on single cell genomics and proteomics reveal its diverse functions in human diseases.pubmed.ncbi.nlm.nih.gov
64. Imaging of pancreatic hepatoid adenocarcinoma: a scoping review.pubmed.ncbi.nlm.nih.gov
65. Case Report: Pancreatic sclerosing epithelioid mesenchymal neoplasm (SEMN) with novel pancreatic duct obstruction in a middle-aged female.pubmed.ncbi.nlm.nih.gov
66. Dynamic volume perfusion CT for preoperative multidimensional resectability assessment of pancreatic ductal adenocarcinoma.pubmed.ncbi.nlm.nih.gov
67. Mixed Neuroendocrine Non-Neuroendocrine Neoplasm of the Ampulla of Vater: Report of a Rare Location.pubmed.ncbi.nlm.nih.gov
68. Diagnosis and Surgical Management for Advanced Pancreatic Cancer Requiring Vascular Resection.pubmed.ncbi.nlm.nih.gov
69. Pancreatic tail cancer in the setting of pancreatitis with a review of the literature: A case report.pubmed.ncbi.nlm.nih.gov
70. Outcomes of surgical treatment in chronic pancreatitis - a single centre study.pubmed.ncbi.nlm.nih.gov
71. Endovascular management of hemosuccus pancreaticus secondary to splenic artery pseudoaneurysm: a case report.pubmed.ncbi.nlm.nih.gov
72. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
73. Acute Pancreatitis as an Initial Presentation of Hereditary Chronic Calcific Pancreatitis with Pancreatic Duct Stones: A Case Report.pubmed.ncbi.nlm.nih.gov
74. Chronic Pancreatitis: Role of Endoscopic Procedures.pubmed.ncbi.nlm.nih.gov
75. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.pubmed.ncbi.nlm.nih.gov
76. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.pubmed.ncbi.nlm.nih.gov
77. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association.pubmed.ncbi.nlm.nih.gov
78. Age-Associated Differences in Ductal Involvement in Biliary Lithiasis: A Consecutive MRCP Cohort Study.pubmed.ncbi.nlm.nih.gov
79. Cone Beam CT Sialography for the Assessment of Submandibular Gland Structure in Diabetes Mellitus.pubmed.ncbi.nlm.nih.gov
80. Technical success, clinical efficacy, and safety of endoscopic minor papilla interventions for symptomatic pancreatic diseases.pubmed.ncbi.nlm.nih.gov
81. The pseudocirrhotic liver: Hepar lobatum carcinomatosum in a patient with triple-negative breast cancer.pubmed.ncbi.nlm.nih.gov
82. Multimodal imaging features to diagnose abdominal complications of sickle cell disease.pubmed.ncbi.nlm.nih.gov
83. Testicular Disorders in Equids: A Case Series.pubmed.ncbi.nlm.nih.gov
84. Diagnostic Uncertainty in Pancreatic Masses: The Critical Role of excluding Malignancy in Suspected Autoimmune Pancreatitis.pubmed.ncbi.nlm.nih.gov
85. A case of chronic cholangitis caused by calculi with foreign matter mimicking perihilar cholangiocarcinoma.pubmed.ncbi.nlm.nih.gov
86. Extraordinary enlargement of the main pancreatic duct dilatation in pancreatic ductal adenocarcinoma - a case report.pubmed.ncbi.nlm.nih.gov
87. Chronic pancreatitis with pancreatic duct stones complicated by acute obstructive suppurative pancreatic ductitis: Report of a case and review of the literature.pubmed.ncbi.nlm.nih.gov
88. Advances in MRI in the Evaluation of Chronic Pancreatitis and the Less Common Forms of Pancreatitis.pubmed.ncbi.nlm.nih.gov
89. Pancreatic masses clinically diagnosed as tuberculosis: Case reports.pubmed.ncbi.nlm.nih.gov
90. EUS-Guided Shear-Wave-Based Elastography: Current Evidence and the Emerging Role of Two-Dimensional Shear-Wave Elastography.pubmed.ncbi.nlm.nih.gov
91. Mucinous cystic neoplasms of the liver: current insights into epidemiology, diagnosis, and treatment.pubmed.ncbi.nlm.nih.gov
92. Staged management of a giant adult Todani type IVa choledochal cyst mimicking gallbladder hydrops.pubmed.ncbi.nlm.nih.gov
93. Clinical Characteristics, ERCP Management, and Early Adverse Events Among Patients with Choledocholithiasis at a Romanian Tertiary Referral Center: A Retrospective Cohort.pubmed.ncbi.nlm.nih.gov
94. A Pancreas Out of Place: Acute Interstitial Pancreatitis Caused by Pancreatic Herniation in a Type IV Paraesophageal Hernia.pubmed.ncbi.nlm.nih.gov
95. Changes Connected to Early Chronic Pancreatitis and Early Pancreatic Cancer in Endoscopic Ultrasonography (EUS): Clinical Implications.pubmed.ncbi.nlm.nih.gov
96. Hepato-pancreato-biliary tuberculosis: A review.pubmed.ncbi.nlm.nih.gov
97. The Role of Endoscopic Ultrasound and Ancillary Techniques in the Diagnosis of Autoimmune Pancreatitis: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
98. Imaging of inflammatory disease of the pancreas.pubmed.ncbi.nlm.nih.gov
99. Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation.pubmed.ncbi.nlm.nih.gov
100. Duodenal imaging on the spotlight: from A to Z.pubmed.ncbi.nlm.nih.gov
101. Unusual Configuration of a Giant Trans-Spatial Pancreatic Pseudocyst with Spontaneous Shrinkage: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
102. Pancreatic duct stones treated by Whipple as a last resort: A case report.pubmed.ncbi.nlm.nih.gov
103. The Role of Imaging in Portal Vein Thrombosis: From the Diagnosis to the Interventional Radiological Management.pubmed.ncbi.nlm.nih.gov
104. Extravertebral low back pain: a scoping review.pubmed.ncbi.nlm.nih.gov
105. Adoption of multi-slice spiral computed tomography and multiparametric magnetic resonance imaging in the differential diagnosis of pancreatic cancer and chronic pancreatitis.pubmed.ncbi.nlm.nih.gov
106. Portal Vein Thrombosis: State-of-the-Art Review.pubmed.ncbi.nlm.nih.gov
107. Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study.pubmed.ncbi.nlm.nih.gov
108. Research on the classification of pancreatic pseudocysts based on individualized treatment protocols.pubmed.ncbi.nlm.nih.gov
109. Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis.pubmed.ncbi.nlm.nih.gov
110. Cystic pancreatic lesions: MR imaging findings and management.pubmed.ncbi.nlm.nih.gov
111. Ultrasound of Bile Ducts-An Update on Measurements, Reference Values, and Their Influencing Factors.pubmed.ncbi.nlm.nih.gov
112. Machine Learning Models for Pancreatic Cancer Risk Prediction Using Electronic Health Record Data-A Systematic Review and Assessment.pubmed.ncbi.nlm.nih.gov
113. Prediction of Pancreatic Cancer Based on Imaging Features in Patients With Duct Abnormalities.pubmed.ncbi.nlm.nih.gov
114. Turkish Society of Gastroenterology: Pancreas Working Group, Acute Pancreatitis Committee Consensus Report.pubmed.ncbi.nlm.nih.gov
115. Diseases of bile duct in children.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.