Case report

We present the case of a 72-year-old woman with a colicky abdominal pain in the right hypochondria of a duration of several months and a weight loss of 10 kg. Echoendoscopy identified a heterogeneous pancreatic parenchyma with areas of a lobular pattern and hyperechoic stripes and a normal Wirsung. The abdominal-pelvic computed tomography (CT) showed an increase in the size of the pancreas with an almost complete replacement of the parenchyma by adipose tissue (Fig. 1A). After the administration of secretin, a cholangiopancreatic MRI showed a fatty infiltration and a normal pancreatic duct with an adequate distension. The secretin confirmed a correct distension of the Wirsung duct, which had returned to its normal caliber, and a reduced exocrine function as there was only a small amount of duodenal filling (Fig. 1B-D).

Fig. 1 A. CT. Axial MIP reconstruction: fatty replacement of the pancreatic parenchyma (white arrow: pancreas head-neck; black arrow: pancreas tail). B-D. Cholangiopancreatic MR coronal images. B. Basal image that identifies a normal pancreatic conduct (white arrow). C. One minute after secretin injection, the pancreatic conduct (white arrow) is at its widest point of dilatation. D. Late image (ten minutes) shows a reduction in the pancreatic duct caliber (white arrow) in relation to C and a small amount of signal intensity in the small bowel due to a poor exocrine function (black arrows). 

Discussion

Among the available imaging techniques, a cholangiopancreatic MRI with secretin is the technique of choice due to its ability to provide morphological information and also functional data of the ductal system. This technique is also able to assess the exocrine function in a semi-quantitative manner ^{3) (4) (5}.

A few differential diagnoses should be considered, as this condition can be confused with a lipoma or liposarcoma when presenting in a focal manner. However, when there is a diffuse involvement of the pancreas, it should be differentiated from chronic pancreatitis, cystic fibrosis and pancreatic lipomatosis. The possibility of diagnosing PLP by a non-invasive imaging technique, allows a conservative management of this condition.