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CC BY-NC-ND 4.0 · Ultrasound Int Open 2020; 06(03): E67-E75
DOI: 10.1055/a-1323-4906
Review

Focal Autoimmune Pancreatitis: A Simple Flow Chart for a Challenging Diagnosis

Clara Benedetta Conti
1   Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy
,
Fabrizio Cereatti
1   Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy
,
Andrea Drago
1   Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy
,
Roberto Grassia
1   Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy
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Abstract

Autoimmune pancreatitis is a chronic fibroinflammatory autoimmune mediated disease of the pancreas. Clinically, obstructive painless jaundice and upper abdominal pain are the main symptoms. Focal AIP is characterized by segmental involvement of pancreatic parenchyma and it is often radiologically represented by a pancreatic mass. In these cases, the diagnosis can be very challenging, since it may be easily confused with pancreatic cancer. Therefore, we suggest a combined approach of imaging tests as the diagnostic workup. EUS study combined with CEUS and elastography, if available, increases the accuracy of the method to rule out cancer. Moreover, the lesion should always be sampled under EUS guidance to obtain a cyto/histological diagnosis. The diagnostic workup should also include the use of diagnostic clinical criteria (extrapancreatic lesions, steroid response) and laboratory findings (CA 19.9 and IgG4 evaluations).

Key words

pancreas - areas - structures & systems - abdomen - areas - structures & systems - endoscopy - methods & techniques - ultrasound


Publication History

Received: 15 September 2020

Accepted after revision: 25 November 2020

Article published online:
19 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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