1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Johnathan l Hadley Affiliation: Eastern Virginia Medical School

2. MedPix No: 7688 - History Pt Demographics: Age = 64 y.o. Gender = man Intractable Nausea and Vomitting Downloaded by (-1)

3. MedPix No: 7688 - EXAM & LABS None available

4. Pancreatic adenocarcinoma Image shows significant narrowing of the duodenal c-loop with concave bowing along the medial side Downloaded by (-1)

5. Pancreatic adenocarcinoma Placing the patient prone nicely demonstrates continued narrowing of the proximal duodenum with a normal diameter distal segment Downloaded by (-1)

6. Pancreatic adenocarcinoma CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum. Downloaded by (-1)

7. Pancreatic adenocarcinoma CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum. Downloaded by (-1)

8. Pancreatic adenocarcinoma CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum. Downloaded by (-1)

9. Pancreatic adenocarcinoma CT of the abdomen shows a large mass in the head of the pancreas; note the normal diameter distal duodenum. Downloaded by (-1)

10. FINDINGS UGI images demonstrate marked narrowing of the proximal segments of the duodenum as well as massive distention of the stomach. The concave deformity along the pancreatic margin of the duodenum has been refferred to as the *reverse three sign of Frostberg.*CT confirms a mass in the head of the pancreas with compression of the duodenum. Note the preservation of the distal duodenal lumen.

11. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? From the UGI only: - Pancreatic Adenocarcinoma - Chron*s - Infiltrating lymphoma - Duodenal wall hemorrhage - Severe post-bulbar ulcer - Duodenal Carcinoma

12. Diagnosis: Pancreatic adenocarcinoma Dx Confirmed by: CT guided biopsy

13. DISCUSSION