E1887. Grooving the Diagnostic Challenges of Groove Pancreatitis
  1. Maria Rizwan Bokhari; University of Rochester Medical Center
  2. Akshya Gupta ; University of Rochester Medical Center
  3. Vikram Dogra; University of Rochester Medical Center
Groove pancreatitis, now known as para duodenal pancreatitis, is an under-recognized but important cause of clinical morbidity commonly seen in males with a history of alcohol abuse and a peak incidence at the age of 40 - 50 years. This umbrella term encompasses a spectrum of pathologic entities involving pancreaticoduodenal groove like cystic dystrophy of the pancreas, para-duodenal wall cysts, localized chronic pancreatitis, and hamartomas. Differentials are also vast and include a gamut of variable neoplastic processes with differing management, such as pancreatic head adenocarcinoma, ampullary carcinomas, neuroendocrine tumors, and duodenal gastrointestinal stromal tumors, as well as typical acute edematous pancreatitis. Moreover, groove pancreatitis can coexist with and mask the appearance of an underlying carcinoma. On account of the anatomical and pathological complexity of this region, the preoperative diagnosis of the disease remains a diagnostic challenge.

Educational Goals / Teaching Points
This educational exhibit aims to elaborate on the etiology, pathogenesis, clinical manifestations, and imaging appearance of groove pancreatitis on modalities including ultrasound, CT, MRI, and MRCP and upper GI endoscopy correlates. We elaborate on the detailed anatomy of this critical space with the help of graphic illustrations and labeled radiologic images. The imaging appearance of other contenders will also be discussed using images.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The pancreatic-duodenal groove is a complex anatomical space along the medial aspect pancreatic head and the duodenal wall. It has several important neurovascular and veno-lymphatic structures in addition to the common bile duct, main and accessory pancreatic ducts, and major and minor papilla.

Knowledge of the imaging appearance of this challenging diagnosis is crucial in managing and differentiating groove pancreatitis from other clinically essential entities in the pancreaticoduodenal groove.