i 223 The Clinical and Imaging Spectrum of Pancreaticoduodenal Lymph Node Enlargement Robert K. Zeman1 Mark Schiebler1 Letitia R. Clark1 Mark H. Jaffe1 David M. Paushter1 Edward G. Grant2 Peter L. Choyke1 Received November 20, 1984; accepted after revision February 5, 1985. Presented at the annual meeting of the Radio- logical Society of North America. Washington, DC, November 1984. 1 Department of RadiolOgy, Abdominal Imaging Division, Georgetown university Hospital, 3800 Reservoir Rd., NW., Washington, DC 20007. Ad- dress reprint requests to R. K. zeman. 2 Department of Radiology, Ultrasound DIVISiOn, Georgetown Uiiversity Hospital, Washington, DC 20007. AJR 144:1223-1227, June 1985 0361 -803x/85/1 446-i223 C American Roentgen Ray Society Pancreaticoduodenal lymph node enlargement, regardless of cause, has been a source of Imaging confusion because of Its propensity to mimic pancreatic malignancy yet not cause billary obstruction. Thirty-eight patients with pancreaticoduodenal ade- nopathy were Imaged with several methods. Pancreaticoduodinal lymphadenopathy could be distinguished from intrinsic pancreatic abnormalfty on only 44% (14/32) of CT scans and 54% (6/11) of sonograms. DemOnstratiOn of lntct tissu planes separating adenopathy from pancreas and, to a lesser degree, extrapancretlc vascular displace- meat were the most helpful diagnostic signs. Surprisingly, 31% of patients had billary obstruction. Care must be taken In distinguishing mOtSItMIC Iymphadnopathy from primary pancreatic tumors. The presence or absence of jaundice should not be consid- ered a h&pful sign. Many metastatic malignancies may involve the anterior and posterior pancreati- coduodenal lymph nodes [i]. These nodes lie between the duodenal sweep and pancreatic head (fig. 1). They are often nonspecifically classified along with the paracaval and superior mesenteric groups as penpancreatic in location. The son- ographic literature has suggested that pancreaticoduodenal lymphadenopathy is only occasionally difficult to distinguish from primary pancreatic malignancies [2]. Likewise, biliary obstruction secondary to pancreaticoduodenal lymph node en- largement has been described as infrequent [2]. To further evaluate the dinical and imaging findings of pancreaticoduodenal lymph node enlargement, the records of 38 patients with this entity were retrospectively reviewed. Materials and Methods Thirty-eight patients with proven pancreaticoduodenal lymphadenopathy of known cause were studied between 1980 and 1984. These cases were selected on the basis of a retrospective medical record review. Only cases of tymphadenopathy not related to panorea c carcinoma were included in the study. Documentation of the nature and cause of Iymphade- nopathy was by exploratory laparotomy in 17 patients, percutaneous guided biopsy in four, and autopsy in four. Thirteen patients had only a combnation of imaging and clinical follow- up to confirm the diagnoSis of pancreaticoduodenal lymphadenopathy. The imaging proce- dures performed induded upper gastrointestinal series (1 2 patients), sonography (1 1), corn- puted tomography (CT) (32), and percutaneous tranthepatic cholangiography (seven). Only eight patients had both sonography and CT. Sonography was performed on static gray-scale or phased-array real-time equipment with 2.25- to 5.0-MHz transducers. Standard projections for delineating the upper abdomen were used. CT was performed on third-generation scanners with a scan time of 9.8 sec or less and dynamic vascular enhancement in most instances. Oral contrast material was routinely used, with decubitus scans added as needed. No CT or sonographic examinations were believed to be nondiagnostic. Three sonographic examinations faded to demonstrate the pancreatic tall but were included in the study as this was anatomically not the primary area ofinterest. Downloaded from www.ajronline.org by 54.163.42.124 on 05/24/20 from IP address 54.163.42.124. Copyright ARRS. For personal use only; all rights reserved