The roentgen diagnosis of early enlargement of the head of the pancreas

Abstract

The roentgenologic diagnosis of early changes in the head of the pancreas is presented with a report of two cases. Roentgenologic changes in the mucosal configuration and contour of the ampullary portion of the duodenum now offer a newer field in the diagnosis of intrinsic and extrinsic pathology affecting this segment of the intestine. Since the majority of lesions of the pancreas involve the head, its close relationship with the ampullary portion of the duodenum is more likely to reveal some abnormality of the duodenum. If more attention is focused upon this area the roentgenologic examination should yield changes leading to a correct diagnosis in many instances. It is now possible to demonstrate the finer details in the configuration of Kirkrings folds by the compression method. Minute changes in the mucosal pattern in the ampullary portion of the duodenum have hitherto escaped our attention. The new roentgen sign illustrated by an inverted three defect in the descending duodenum is produced by pressure of the head of the pancreas. The mucosal markings are displaced but not effaced by this pressure. The roentgen sign described as being due to disease of the head of the pancreas, though indicative of pressure does not in itself determine the etiologic factor, as any pathologic process involving the head may produce a similar picture. However the roentgen demonstration of pressure due to slight enlargement of the head of the pancreas aids in localizing the lesion and with further corroboration of the clinical and other laboratory data is of inestimable value in the diagnosis of early pancreatic affections.