A 43-year-old woman with a history of childhood meningitis, gestational diabetes mellitus and gestational stasis.
The patient was previously diagnosed with idiopathic chronic pancreatitis and was admitted to our service with epigastric abdominal pain of 48 hours duration associated with obstructive pancreatitis.
A contrast-enhanced abdominal CAT scan identified multiple pancreatic calcifications, with an increase in the head of the pancreas (about 6 cm in diameter) and a duodenum loss of fat with layers.
There is a slight dilation of the main pancreatic duct, as well as a large number of periaortic balloon and mesenteric adenopathies.
The diagnosis of suspected inflammatory mass is established in the context of chronic pancreatitis, without ruling out pancreatic adenocarcinoma.
EUS was performed, confirming the presence of a mass in the pancreatic head, heteroechogenic, irregular, poorly delimited, with the presence of scattered soft tissue calcifications, both in relation to the lesion as in the rest of the parenchyma).
The main pancreatic duct is dilated, with hyperechogenic wall, irregular pattern and dilatation of collaterals.
Pancreatic lesion affects the main bile duct, with secondary dilation of it.
During EUS, an elastographic study was performed.
In the baseline study a heterogeneous pattern of green predominance was observed, and in the second generation elastography study an elasticity coefficient of 2.35 and an A value of 0.12% were observed.
Finally, a 22G needle aspiration puncture was performed, observing characteristic findings of an inflammatory mass in the context of chronic pancreatitis (18).
Finally, endoscopic retrograde cholangiography was performed with placement of a polyethylene prosthesis.
The patient recovered satisfactorily and was asymptomatic after three months of follow-up.
