Pancreatic Inflammatory and Neoplastic Diseases — WACS Viva & Clinical Scenarios (Gastrointestinal and Abdominal Imaging)

Exam-style pancreatic inflammatory and neoplastic diseases viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 46-year-old male presents with severe epigastric pain radiating to the back and markedly elevated serum lipase. An abdominal contrast-enhanced CT performed 96 hours post-onset demonstrates patchy non-enhancement involving approximately 45 percent of the pancreatic body and tail, alongside ill-defined heterogeneous retroperitoneal collections containing non-liquid solid attenuation components without a defined wall. What is the most accurate diagnosis according to the Revised Atlanta Classification, and what is the calculated Modified CT Severity Index score category?
• SCENARIO 2: A 62-year-old female presents with painless progressive jaundice, dark urine, and unintended weight loss. A multiphasic pancreatic-protocol CT demonstrates a 2.8 cm ill-defined, hypoattenuating mass in the pancreatic head causing dilatation of both the main pancreatic duct and common bile duct (double duct sign). Multiplanar reformatted images show 210 degrees circumferential abutment of the superior mesenteric vein with focal contour deformity and vessel narrowing, with 120 degrees abutment of the superior mesenteric artery without contour irregularity. Outline your structured radiological re
• SCENARIO 3: A 52-year-old female undergoes an abdominal ultrasound for non-specific dyspepsia, revealing an incidental 3.5 cm cystic mass in the pancreatic body. Subsequent MRI and MRCP reveal a multilocular cystic lesion containing thick internal septations and peripheral eggshell-like wall calcifications, without communication with the main pancreatic duct. What is the most likely diagnosis, and what imaging features distinguish it from serous cystadenoma and side-branch intraductal papillary mucinous neoplasm (IPMN)?
• SCENARIO 4: A 58-year-old male presents with recurrent episodes of dull abdominal pain, steatorrhoea, and newly diagnosed diabetes mellitus. Contrast-enhanced CT and MRCP reveal diffuse parenchymal atrophy, coarse intraductal calcifications, and alternating segments of dilatation and stricturing of the main pancreatic duct (chain-of-lakes appearance). Contrast this appearance with the cross-sectional imaging features of type 1 autoimmune pancreatitis (AIP) and paraduodenal (groove) pancreatitis.
• SCENARIO 5: A 50-year-old male with a history of severe necrotising pancreatitis six weeks prior develops persistent low-grade fevers and worsening epigastric fullness. Contrast-enhanced CT reveals a well-circumscribed, encapsulated 10 cm collection with a thick enhancing wall containing liquid and non-enhancing non-liquid necrotic debris, abutting the posterior gastric wall. Within the wall of the collection, a 1.5 cm intensely enhancing focal outpouching arising from the splenic artery is noted. Describe the immediate diagnostic priorities, classification of the fluid collection, and the correct procedu