Arteriographic Diagnosis of Pancreatic Lesions

The diagnosis of lesions of the pancreas can often be established only with difficulty by clinical and laboratory technics. Roentgenological methods, until recently, have not been of value except in advanced disease (3). Only gross enlargement of the pancreas as the result of pancreatitis, pancreatic cysts, or tumors may displace the duodenum or the stomach. Large tumors may also be demonstrated after retroperitoneal air insufflation, by transhepatic cholangiography, splenoportography, and isotope scanning. Small pancreatic masses and minor enlargement of the pancreas, however, escape diagnosis with these technics (7, 8). It was hoped that angiography would improve the diagnostic accuracy in this group of patients. Arteriography has received enthusiastic support by some investigators (11) and less optimistic regard by others (1, 9, 14). Clinically advanced lesions (pancreatitis, cysts, or tumors) can be confirmed frequently by angiography. No well documented series exists, however, which shows whether early lesions of the pancreas with limited or questionable clinical symptomatology can be diagnosed by angiography. Technic A yellow Ödman catheter is introduced into each femoral artery, according to the Seldinger technic, and positioned selectively into the celiac axis and superior mesenteric artery, respectively. A total amount of 60 to 70 cc of contrast material is injected simultaneously into both catheters by a pressure syringe, and serial films are taken in the supine and, if necessary, in the right posterior oblique position. Careful preparation of the patient prior to the procedure is of utmost importance, and the bowel must be clean of fecal material and gas. For visualization of the tail of the pancreas, the stomach may be distended by gas. Material From our angiographic material, 47 cases were selected for this evaluation. The indication for the examination in these patients was the presence of un-diagnosed abdominal pain with or without weight loss. The pain was usually present continuously, radiating to the back. Clinical and laboratory work-up on these patients had been unrevealing. In particular, upper gastrointestinal radiologic examinations and dudodenal cytology were normal in all cases. Duodenal drainage and amylase determinations were normal or inconclusive. In some patients, retro-peritoneal air insufflation and splenoportography were performed with negative results. Findings Displacement or invasion of vessels or the presence of tumor vessels was considered a pathologic finding. Out of the 47 cases, the arteriogram was abnormal in 15 and surgery confirmed the angiographic diagnosis. Thirty-two arteriograms were normal. Nineteen of these patients underwent laparotomy in spite of the normal angiogram; in 13 of these an abnormality was discovered at surgery.