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X Ray - Pancreatic calcification

posted Jan 31, 2010, 9:26 PM by Amila Ratnayake   [ updated Feb 2, 2010, 5:03 AM ]

Traditionally pancreatic calcification have been largely associated with chronic calcific pancreatitis from alcohol abuse ( 90% of time ). Although alcohol abuse remains the predominant cause of pancreatic calcification, many other causes also deserve attention.
Knowing what entities cause calcification and their typical appearances can help in an accurate diagnosis. However imaging alone cannot be trusted for a definitive diagnosis because many of these entities overlap in their appearance ( AJR 2002;178: 79-86 )
Chronic calcific pancreatitis is the most common cause of pancreatic calcification world wide. The characteristic pathological changes are well known. The ducts become obstructed by proteinaceous plugs that can eventually accumulate calcium carbonate. This obstruction results in ductal ectasia and periductal fibrosis. The calculi occurs in ducts of all sizes and vary from microscopic to greater than 1 cm in diameter.
The radiographic appearance is generally that of numerous irregular small calcifications throughout the pancreas. The head of the pancreas is usually involved more predominantly then the tail. The degree of calcification appears to parallel the course of the disease.
Chronic pancreatitis caused by hyper parathyroidism, tropical pancreatitis or idiopathic pancreatitis can also result in intraductal calculi. Notably other causes of pancreatitis including drugs, trauma, and viruses do not characteristically cause pancreatic calcification.

Less common causes for pancreatic calcification

 Entity Characteristics
Hereditary Pancreatitis       ( Paediatric population )  Large rounded calcifications. Positive family history
 Cystic fibrosis  Fine granular calcification in smaller pancreatic ductal radicals
 Islet cell tumors
Cyst adenoma/ Cyst adenocarcinoma
Cavernous lymphangioma
 Radiating spoke like pattern in cyst adeno carcinoma
 Senescent ( elderly )  
protein malnutrition    ( developing countries)  
 Mimics- Splenic artery calcification   Tram road pattern
Pancreatic calcification and cancer

The most common primary pancreatic tumor , ductal adeno carcinoma characteristically does not calcify. About 2 - 4 % of patients with pancreatic calcification have coexisting pancreatic carcinoma. It is suspected to be due to , pancreatic carcinoma developing in a pancreas with underlying chronic calcific pancreatitis or calcification develop in the setting of chronic pancreatitis from an obstructing ductal adenocarcinoma.
A number of less common tumors have associated calcifications. Islet cell tumors are known for the presence of tumoral calcification. in cyst adenoma and cyst adenocarcinoma there is 10% actual tumor calcification.
Suggested readings.
  1. Robert J lesniak. Spectrum of causes of pancreatic calcification AJR 2002 : 178: 79-80
  2. Joseph L owens Jr . Pancreatic calcification . a late sequel in the natural history of chronic alcoholism and alcoholic pancreatitis. Ann. Surg 1958 March; 147(3) :326- 338