主诉黄疸的免疫性胰腺炎影像学表现.pdfVIP

Salil Garg, HMS III Dr. Gillian Lieberman Autoimmune Pancreatitis Presenting with Jaundice Salil Garg, Harvard Medical School, Year III Gillian Lieberman, M.D. Salil Garg, HMS III Dr. Gillian Lieberman Our patient: A 73 yo male presenting with obstructive jaundice, history of autoimmune pancreatitis Salil Garg, HMS III Dr. Gillian Lieberman Autoimmune Pancreatitis (AIP) • Relatively rare, representing 5%-11% of chronic pancreatitis • Twice as common in men as women • Wide variance in age, most cases 50 yo • Most common presentation is jaundice or abdominal pain. Acute pancreatitis presentation is rare. Salil Garg, HMS III Dr. Gillian Lieberman Criteria for AIP Diagnosis • No gold standard, HISORT used most frequently in United States • Histology • Periductal infiltrate, T lymphocytes and plasma cells (IgG4+) • Imaging • Diffuse pancreatic enlargement, or focal mass • Serology • Hypergammaglobulinemia, Highly elevated IgG4 is specific but not sensitive • Other organ involvement • Gallbladder, bile ducts, kidney, lung, salivary glands • Response to Steroid Treatment • Glucocorticoids (prednisolone) Salil Garg, HMS III Dr. Gillian Lieberman Causes of Pancreatitis • Acute – Alcohol – Gallstones – Metabolic – Drugs – Infection • Chronic – Alcohol – Cigarette smoking – Hereditary/Congenital – Obstruction – Tropical pancreatitis – Idiopathic • Autoimmune Salil Garg, HMS III Dr. Gillian Lieberman Companion Patient I: Usual Signs of Pancreatitis on CT…. Diffusely enlarged