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Journal of Medical Ultrasonics

, Volume 29, Issue 3, pp 137–148 | Cite as

Abdominal ultrasonogram of autoimmune pancreatitis: Five cases of pancreatic lesions accompanied by Sjögren syndrome

  • Hideo Yoshizaki
  • Kazuo Takeuchi
  • Chikao Okuda
  • Hajime Honjyo
  • Takatugu Yamamoto
  • Tetuo Kora
  • Yoriyuki Takamori
Translation of Case Report
  • 46 Downloads

Abstract

The concept of autoimmune pancreatitis has recently been established, and ultrasonographic findings we obtained from five cases consistent with autoimmune pancreatitis are reported here. Case 1, a 77-year-old man, was admitted complaining of loss of body weight. Serum hepatobiliary enzymes and γ-globulin levels were elevated, and antinuclear antibody was positive, Abdominal ultrasonography showed dilatation of the intrahepatic bile duct, wall thickening of the common bile duct and hypoechoic swelling of the pancreatic head and body. ERCP revealed multiple stenosis of the intra-and extra-hepatic bile ducts, and diffuse irregular narrowing of the main pancreatic duct. The patient complained of thirst, and the minor salivary gland was examined histologically. Our diagnosis was Sjögren syndrome accompanied by sclerosing cholangitis and a pancreatic lesion. Obstructive jaundice also developed, and PTCD was therefore performed. Both the pancreatic swelling and multiple stenosis of the bile duct improved after steroids were administered. Case 2, a 71-year-old man, was admitted with jaundice. Abdominal ultrasonography showed hypoechoic swelling of the pancreas. ERCP showed stenosis of the common bile duct in the pancreatic head region and diffuse irregular narrowing of the main pancreatic duct. Histological examination of the minor salivary gland suggested Sjögren syndrome. Steroids were therefore administered because the presence of both hyper-γ-globulinemia and positive antinuclear antibody suggested involvement of the autoimmune mechanism. Steroid therapy improved the jaundice as well as the findings from the cholangiograms and pancreatograms. We also encountered three similar cases, all consistent with the concept of autoimmune pancreatitis. The ultrasonographic findings of the pancreatic lesion (1) showed them as homogeneous and markedly hypoechoic areas and, (2) visualized the main pancreatic duct in the lesion, which facilitated a differential diagnosis of the neoplastic lesions. (3) Steroid therapy effectively decreased the hypoechoic area; in some cases, however, a hypoechoic area remained around the main pancreatic duct.

Keywords

autoimmune pancreatitis chronic pancreatitis Sjögren syndrome steroid ultrasonography 

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References

  1. 1).
    Watanabe S: Autoimmune pancreatitis. J. Bil. Panc 1996; 17 (3): 239–244. [in Japanese]Google Scholar
  2. 2).
    Yoshida K, Toki F, Takeuchi T, et al.: Chronic pancreatitis caused by an autoimmune abnormality-Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40: 1561–1568.PubMedCrossRefGoogle Scholar
  3. 3).
    Iwabe C, Watanabe S, et al.: A case of successful corticosteroid treatment of chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct complicated by Sjogren's syndrome. J Jpn Panc Soc 1996;11: 45–55. [in Japanese]Google Scholar
  4. 4).
    Kazuo Takeuchi, Mituyo Hashimoto, et al.: 3 cases of pancreatic mass lesion accompanied by systemic diseases. Jpn J Med Ultrasonics 1986; 13 Suppl I: 721–722. [in Japanese]Google Scholar
  5. 5).
    Sarles H, Sarles JC, Muratore R, et al.: Chronic inflammatory sclerosis of the pancreas-an autonomous pancreatic disease? Am J Dig Dis 1961;6: 688–698.PubMedCrossRefGoogle Scholar
  6. 6).
    Kojima K: Pathology of pancreatitis—About the cases of unknown origin—. Journal of clinical adult diseases 1977;7: 151–157. [in Japanese]Google Scholar
  7. 7).
    Nakano S, Takeda I, Kitamura K, et al.: Vanishing tumor of the abdomen in patient with Sjögren's syndrome. Dig Dis 1978;23: 75–79.CrossRefGoogle Scholar
  8. 8).
    Katoh T, Nakano S, et al.: Two cases of chronic pancreatitis with marked swelling of the gland. J Jpn Panc Soc 1992;7: 64–70 [in Japanese]Google Scholar
  9. 9).
    Tuchie T, Hutamura Y, et al.: Pathogenesis of idiopathic chronic pancreatitis.—Pathohistological study of idiopathic chronic pancreatitis characterized by diffuse swelling of the pancreas. proceedings of Japanese pancreas study group 1985;15: 292–293. [in Japanese]Google Scholar
  10. 10).
    Japan Pancreas Society: Clinical diagnostic criteria of chronic pancreatitis. J Jpn Panc Soc 1995;10: XXIII-XXV. [in Japanese]Google Scholar
  11. 11).
    Doki H, Tadokoro Y, et al.: Chronic pancreatitis from the view point of ERCP. J. Bil. Panc 1994;15 (7): 649–657. [in Japanese]Google Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2002

Authors and Affiliations

  • Hideo Yoshizaki
    • 1
  • Kazuo Takeuchi
    • 2
  • Chikao Okuda
    • 2
  • Hajime Honjyo
    • 2
  • Takatugu Yamamoto
    • 2
  • Tetuo Kora
    • 3
  • Yoriyuki Takamori
    • 4
  1. 1.Department of GastroenterologySapporo Tokushukai HospitalSapporoJapan
  2. 2.Department of GastroenterologyToranomon HospitalTokyoJapan
  3. 3.Second Department of Internal MedicineToho University School of MedicineTokyoJapan
  4. 4.Department of Internal MedicineTeikyo University School of MedicineTokyoJapan

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