Challenges for clinicians treating autoimmune pancreatitis: Current perspectives

Figure 1 Computed tomography features of autoimmune pancreatitis. A: Kidneys (black arrows); B: Aorta (white arrow); C: Lacrimal glands (open white arrow); D: Parotid glands (open black arrow); E: Bile duct (white arrow heads); F: Retroperitoneum (black arrow heads).

Figure 2 Computed tomography and magnetic resonance imaging findings of autoimmune pancreatitis. A: Axial computed tomography (CT) image shows “sausage-like appearance” of diffuse enlargement of the pancreas with absence of pancreatic clefts (white arrows); B: Delayed enhancement (open white arrow) with swelling of the pancreatic tail; C: Hypotonic band (white arrow heads), called the “capsule-like rim”, around the pancreas; D: Axial CT image demonstrates a homogenous enhanced mass (black arrow) with proven autoimmune pancreatitis in the pancreas head mimicking pancreatic ductal adenocarcinoma; E: A pancreatic-phase dynamic contrast-enhanced magnetic resonance imaging (MRI) shows a mild arterial enhanced mass-like lesion (black arrow) with a penetrating duct sign (white arrow); F: An MRI cholangiopancreatography image shows irregular narrowing of the main pancreatic duct (white arrows) without upstream dilatation and short segment stricture of the common bile duct (open white arrow).

Figure 3 Endoscopic ultrasound appearance of autoimmune pancreatitis. A: Hypoechoic diffuse pancreatic enlargement with patchy and coarse heterogeneous parenchyma; B: Mass-like lesion (open white arrow); C: Common bile duct wall thickening (white arrow) with heterogeneous pancreatic parenchyma; D and E: Contrast-enhanced endoscopic ultrasound features of mass forming autoimmune pancreatitis showing (D) homogenous hyper-enhancement mass (white arrows) without irregular internal vessel in the arterial phase and (E) wash-out (white arrows) in the venous phase.