Pancreatic and Extrapancreatic Features in Autoimmune Pancreatitis Michael G. Kozoriz, MD, PhD, Tracy M. Chandler, MD, Roshni Patel, MD, Charles V. Zwirewich, MD, Alison C. Harris, MD  Canadian Association of Radiologists Journal  Volume 66, Issue 3, Pages 252-258 (August 2015) DOI: 10.1016/j.carj.2014.10.001 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 A contrast-enhanced computed tomography of a 65-year-old male with autoimmune pancreatitis. The pancreas is diffusely enlarged with a “sausage” type appearance with a surrounding hypoattenuating capsule-like rim (arrows) (A). One month after steroid treatment demonstrates that the pancreas (arrow) has re-acquired its normal morphology and the hypoattenuating capsule is no longer seen (B). Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 A 62-year-old man with autoimmune pancreatitis with diffuse pancreatic involvement. Axial transabdominal ultrasound shows a diffusely hypoechoic and enlarged pancreas. The biliary tree, kidneys, and prostate were also involved (not shown). Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 3 Contrast-enhanced computed tomography in a 63-year-old male with autoimmune pancreatitis. The pancreatic parenchymal phase image (A) demonstrates a focal hypoattenuating lesion within the tail of the pancreas (arrow). The portal venous phase image (B) of the tail of the pancreas demonstrate retention of contrast and an isoattenuating lesion, within the indicated region (arrow). The delayed enhancement characteristic is useful in distinguishing AIP from adenocarcinoma, which remains hypoattenuating on the portal venous phase. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 61-year-old male with a focal mass in the pancreatic head. The mass (arrow) is hypointense on T2-weighted imaging (A) and mildly hypodense (arrow) on contrast-enhanced computed tomography (CT) (B). There was no associated dilatation of the main pancreatic duct (arrows) seen on both T2-weighited imaging (C) or CT (D). Magnetic resonance cholangiopancreatography images obtained (E) redemonstrate the large mass in the pancreatic head (arrow) and endoscopic retrograde cholangiopancreatography (F) demonstrates marked narrowing of the common bile duct corresponding to the site of the mass (arrow). This patient underwent a Whipple’s procedure and the mass was subsequently pathologically proven to be autoimmune pancreatitis. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 5 A contrast-enhanced computed tomography image obtained from a 59-year-old male with autoimmune pancreatitis showing biliary tree dilatation. A dilated, thickened, and enhancing bile duct wall is shown (black arrow). A biliary stent is present in situ (white arrow). Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 6 Endoscopic retrograde cholangiopancreatography images from a 59-year-old male with pancreatic features of autoimmune pancreatitis. The intrahepatic ducts appear irregular and the common bile duct is moderately dilated. The common bile duct has been cannulated. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 7 A parotid ultrasound from a patient with autoimmune pancreatitis with bilateral painless swelling of the glands. (A) Multiple prominent lymph nodes are found within the left submandibular region. Fine needle aspiration of the largest lymph node revealed abundant IgG4-bearing plasma cells. (B) The parotid glands were heterogeneous in appearance and contained multiple hypoechoic nodules. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 8 Contrast-enhanced computed tomography in a 65-year-old with autoimmune pancreatitis. On the pre-treatment computed tomography image (A), circumferential soft tissue thickening surrounds the aorta. Following steroid therapy (B) the mass has reduced in size. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 9 Contrast-enhanced computed tomography of a 65-year-old male with autoimmune pancreatitis and bilateral renal masses. The masses appear as wedge-shaped hypoattenuating areas (arrows), which could be confused with pyelonephritis or other pathology (A). These “pseudomasses” resolved (arrows) following steroid treatment (B). Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 10 Contrast-enhanced computed tomography in a 57-year-old male with autoimmune pancreatitis. The prostate (p) is diffusely enlarged and heterogeneously hypoattenuating, and there is periprostatic fat stranding. This appearance may be confused with prostatic malignancy or prostatitis. Canadian Association of Radiologists Journal 2015 66, 252-258DOI: (10.1016/j.carj.2014.10.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions