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Gastroenterology  (Expert Forum)
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Calcification in tail of Pancreas
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Calcification in tail of Pancreas

by Mom2one, Oct 08, 2005 12:00AM
I am a 35 year old female.  Over the past couple of years, I began experiencing abdominal pain in a very specific area of my upper left abdomen about two inches to the left of my midline below ribs.  I saw my general doctor about this pain a couple of years ago, and was told I was probably just constipated, or it could be stress.  Went back maybe 6 months later for the same problem, got the same response, but this time some swelling in my leg was noted, with several purplish veins all over my calf.  A d-dimer was done.  It was high.  That d-dimer has been repeated over the past 1 1/2 or so several times, and it is always high.  I've had a clear VQ and doppler.  Went to hematologist that couldn't figure out why dimer would be high other than an underlying malignancy that wasn't really presenting itself at that time.  This pain in the upper left has increased tremendously over the past year.  In May of '05 I went back to  doctor, told him the pain was getting worse, and I also had this pain and swelling in my hip and lower left abdomen region that circled around my back.  It is as though there is fluid accumulation there.  Again, not too concerned, but sent me for a cat scan.  The impression from the scan in May '05.

CT of the chest....

*Soft tissue density at the anterosuperior mediastinum suggestive of residual thymic tissue.

*Small mediastinal lymph nodes at the a-p window. Lymph node to the left of the aortic arch inferiorly.

*Small peripheral nodular density at the left lung base laterally which abuts the pleural surface. Few small pleural based densities.

*Spleen and liver at upper limits in size

CT of Abdomen and Pelvis

*Calcification in the region of the tail of the pancreas and inferior stomach.

Small cystic structres in the right ovary.

The report said that if no intervention is planned, a follow up in 6 months should be done.

I started to have diarrhea in the beginning of August of '05, and with undigested food for two weeks now. Went back beginning of September to same doctor, told him that the abdominal pain was waking me up in the night now, nothing helps it, I am more exhausted than ever.  Simply plagued by horrible fatigue with no energy.  Sent me for a CT scan.  The office lost my chart, so I found a new doctor, had the report sent to him, and the findings were the same as in May.  So..Sunday evening I had another abdominal ct scan with pancreatic protocol.  I phoned the office on Thursday afternoon, and the doctor called me back.  Said that there is this calcification in the tail of the pancreas, but there was no mention of a "tumor".  He said he'd have his medical assistant schedule me for an upper endoscopy to get a further look. She called me after scheduling the upper endoscopy which will be on NOVEMBER 23.  I am concerned that this upper endoscopy is not what I need.Should I call new doctor to speak with him personally about my concerns?  I am truly desperate.  Would like to find good doc in Mich. Thank you.
Doctor's Answer

by Kevin Pho, MD, Oct 09, 2005 12:00AM
The upper endoscopy is a reasonable next test to evaluate for other possible causes of your symptoms - including GERD, an ulcer, or inflammation of the upper digestive tract.  



If you continue to have concerns, you should always discuss them with your doctor.  Calcification of the pancreas can be from chronic pancreatitis.  If further evaluation is needed, an endoscopic ultrasound as well as an MRI can be considered.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

http://www.straightfromthedoc.com
Member Comments (23)

by Mom2one, Oct 08, 2005 12:00AM
All tests have (generally) been normal.  I've had mild neutropenia, and a consistely slightly low rbc and high rdw, yet nothing to alarm anyone.  The tests you mentioned, fibrinogen, ptt, were all within normal limits.  The only test that has been high is the d-dimer.  When I saw the hematologist, he said it was DIC, but that he didn't want to take any measures since all of the other tests were normal. He thought maybe the purplish vein-type marks on my lower leg could be elevating the dimer results.  9 days ago, my husband took me to the ER because pain woke me from a deep sleep, and actually made me cry.  I was absolutely miserable.  The pain was worse, again in that one isolated area of my upper left abdomen, than the first day after my c-section when they told me to walk around!  The ER doctor ran cbc, amylase and lipase tests, all of which were normal.  He said that maybe I had a kindey stone from the appearance of all the blood in my urine.  I had to chuckle because I told him, "Well, that's probably because my menstrual cycle started today".  He said he didn't know what was going on, and to check-in with my general doctor.  This whole not feeling well every day is absolutely draining me.  The diarrhea every day is hard, too, and now with the passing of undigested food as of late doesn't help.  Gosh, I really thank you for taking the time to read my little scenario.  I know I'm not the only person with these sorts of troubles.  I empathize will everyone who suffers.  I just honestly feel like I am gravely ill.  My mother was diagnosed with acute leukemia two years ago.  For the several months before her diagnosis, she was told she had some sort of flu bug, a virus, and the latest was anxiety over whether or not to retire.  Well, it was none of the above.  Anyways, thank you, again.

by Mom2one, Oct 08, 2005 12:00AM
Sarah, forgot to answer...I'm not familiar with the ventilation perfusion scan.  Is that the VQ scan of the lungs?  If so, it was negative.

by Mom2one, Oct 09, 2005 12:00AM
Sarah, thank YOU for your time.  Yes, sed rate and CRP have always been within normal limits. The only other tests I've forgotten to mention are Hepatitis, all of which were negative.  My "gut feeling", though I'm not a medical professional, is that something is going on with my pancreas. The abdominal pain in that area, undigested food, pain in back.  Could this calcification in the tail represent something sinister (e.g. islet cell, or other cancer?) The new doctor that I began seeing a month ago was wondering if I had Trousseau's syndrome.  However, from what I know, the upper endoscopy does not explore the pancreas.  On my last scan, my liver and spleen were also noted to be at the upper limits in size.  Just wondering if there is a connection with that.  No, they've never mentioned the vena cava or hypertension.  I had a time during the summer where my alt and ast were doubled, but they've since gone back to normal.  By the way, I still have this curious fluid collection around left hip, lower left abdomen that carries around to my back area.  Thank you very kindly, Sarah, for your help.

by TJV, Oct 09, 2005 12:00AM


You said . "Endoscopy isn’t the preferred method to visualize the pancreas"



Upper endoscopy doesn't visulize the pancreas at all. :)  Endoscopy looks at the esophagus , stomach