Groove pancreatitis: A Case Report and Review of the Literature

Abstract

Groove pancreatitis is a rare form of segmental chronic pancreatitis. It involves the anatomic space between the head of the pancreas, the duodenum and the common bile duct. It was first described in the early 1970s, but it remains largely unfamiliar to most physicians. Radiological diagnosis can be challenging, as it is often difficult to differentiate it from other entities. The differential diagnosis from pancreatic head carcinoma may be difficult and recognition of subtle differences between these two entities is extremely important as the management differs significantly. Groove pancreatitis can be managed by conservative medical treatment, and surgery is reserved only for patients with persistent and severe clinical symptoms. We present a case of a 27 year-old male with groove pancreatitis and discuss the Magnetic Resonance Imaging (MRI) appearance of this entity as well as the differential diagnosis.

Keywords: Chronic pancreatitis; Groove pancreatitis; MRI; Magnetic Resonance Imaging.

Figure 1

A 27 year-old male with groove pancreatitis. Abdominal MRI. Transverse (a) and coronal (b) T2-weighted half-Fourier single-shot turbo spin-echo (SSTS-SE) images with and without fat-suppression, precontrast out-of-phase and in-phase 2D breath-hold dual echo gradient recalled echo (c, d), and postcontrast 3D-GRE fat-suppressed T1-weighted sequences in the transverse plane on the arterial (e), portal venous (f) and delayed (g) phases. The T2-weighted images demonstrates slightly hypointense sheet-like mass in the pancreatoduodenal groove, with cystic changes (arrow, a), and mild dilatation of the common bile duct with long and smooth tapering (b); The T1-weighted images shows an hypointense sheet-like mass (arrow, c) bordered by the duodenum (white *, c) and extending into the pancreatic head (arrow, d). On immediate postgadolunium image is observed imperceptible enhancement (arrow, e) in the mass located between the duodenum (white *, e) and the pancreatic head (black *, e). On the portal venous phase is appreciated patchy enhancement (arrow, f), and greater enhancement is demonstrated on the delayed phase (g). (Parameters - Field strength: 1,5 T; T2 SSTS-SE: TR - 1500, TE - 85; T1 in/out-of-phase: TR - 170, TE - 2.2/4.4; T1 3D-GRE FS post-contrast: TR - 3.8, TE - 1.7; Contrast: MultiHance, Bracco Diagnostics, Milan, Italy, at 2 ml/s followed by a bolus 20 ml of saline flush)

Figure 1

A 27 year-old male with groove pancreatitis. Abdominal MRI. Transverse (a) and coronal (b) T2-weighted half-Fourier single-shot turbo spin-echo (SSTS-SE) images with and without fat-suppression, precontrast out-of-phase and in-phase 2D breath-hold dual echo gradient recalled echo (c, d), and postcontrast 3D-GRE fat-suppressed T1-weighted sequences in the transverse plane on the arterial (e), portal venous (f) and delayed (g) phases. The T2-weighted images demonstrates slightly hypointense sheet-like mass in the pancreatoduodenal groove, with cystic changes (arrow, a), and mild dilatation of the common bile duct with long and smooth tapering (b); The T1-weighted images shows an hypointense sheet-like mass (arrow, c) bordered by the duodenum (white *, c) and extending into the pancreatic head (arrow, d). On immediate postgadolunium image is observed imperceptible enhancement (arrow, e) in the mass located between the duodenum (white *, e) and the pancreatic head (black *, e). On the portal venous phase is appreciated patchy enhancement (arrow, f), and greater enhancement is demonstrated on the delayed phase (g). (Parameters - Field strength: 1,5 T; T2 SSTS-SE: TR - 1500, TE - 85; T1 in/out-of-phase: TR - 170, TE - 2.2/4.4; T1 3D-GRE FS post-contrast: TR - 3.8, TE - 1.7; Contrast: MultiHance, Bracco Diagnostics, Milan, Italy, at 2 ml/s followed by a bolus 20 ml of saline flush)

Figure 2

A 27 year-old male with groove pancreatitis. Endoscopic ultrasound demonstrates a heterogeneous and predominantly hypoechoic mass (arrows, a) with scattered calcifications and poorly defined margins located between the pancreatic head and the duodenum (a, b), mild dilatation of the common bile duct is appreciated with long and smooth tapering in the distal third (b). (Transducer frequency - 7.5 MHz).

Figure 3

A 27 year-old male with groove pancreatitis. Microphotography shows marked hyperplasia of Brunner’s glands in duodenal wall, mild villosities atrophy and inflammation. No malignant cells were recognized (HE stain).