Imaging description

Pancreatic clefts are usually found at the junction of the neck and body. Histologically, they represent peripancreatic fat trapped within normal tissue, and they are found where vessels penetrate the pancreatic parenchyma [1]. Clefts typically appear smooth and linear with well-defined margins. On CT fat is typically visible, and they do not completely traverse the full width of the gland (Figures 60.1 and 60.2). The presence of fat surrounding penetrating vessels arising from the pancreatic arteries is indicative of a cleft [1]. Pancreatic clefts can be confused with a pancreatic laceration or transection on contrast-enhanced CT.

The lateral margin of the head and neck of the pancreas is normally convex. Lobular contour abnormalities, reported in up to 35% of normal subjects, are most common near the junction of the head and neck [2]. A deep fissure separating these lobules can be mistaken for laceration while the lobulations themselves can be misinterpreted as a pancreatic mass. Pancreatic lobulations, and the clefts that separate them, increase with age and they should not be misinterpreted as lacerations (Figure 60.3).