A common incidental finding on CT is a small low density lesion of the pancreas. By small we usually mean less than a centimeter. By low density, we mean darker in appearance than the normal pancreas next to it. Usually these are small dark dots in the pancreas that are often too small to say for sure what they are.
Often, these small dark dots in the pancreas are benign. They may represent fat within the pancreas but are too small to say for sure. Other times, these are small cystic lesions that can grow an have a small risk of cancer. In many cases, an abdominal MRI will be done to take a closer look. Often, the abdominal MR will make it possible to determine if the spot is benign and can be ignored or followed over time with established guidelines.
Im some cases, there may be features which require a more aggressive treatment such as surgery. The MRI will best show these features which may include a more complex cyst or dilation of the pancreatic duct. A symptomatic cyst may also require treatment. A cyst which grows over time or is large may also need treatment with surgery. A specially trained gastroenterologist may sample the cyst using endoscopic ultrasound which can help determine the diagnosis.
Most commonly, these small dark spots on CT in the pancreas are benign. Often the small cystic lesions filled with fluid will be followed. Most grow slowly over time. It is rare to see a cancer develop but that is the main concern. I have seen these cysts be stable or grow very slowly over many years.
It is rare for these small dark spots to be the deadly pancreatic cancer (adenocarcinoma). Often, pancreatic cancer has a more aggressive look to it even when small. Getting an abdominal MRI will be most helpful for a closer look. If there is any concern for pancreatic cancer, than an endoscopic ultrasound and sampling may follow by a specially trained gastroenterologist. Comparison with any prior imaging is also helpful, to say if something is new.
A small low density lesion of the pancreas on CT is often benign. A specific diagnosis can not be made in many cases. An abdominal MRI will often be recommended to make a specific diagnosis or establish a follow up regimen. In cases where there is concern for cancer based on the imaging features or your symptoms such as jaundice or pain, a biopsy or surgery may be needed. It is therefore important for your clinical doctor to use the information in the radiology report and combine it with your history and laboratory values.