Fig 1. — CT scan of the abdomen through the level of the pancreas. The scan was performed with contrast administration and spiral acquisition. This scan shows a focal, hyperdense lesion of approximately 1 cm in diameter in the tail of the pancreas (arrow).	Fig 2. — The same axial scan as Fig 1 but with a narrower window-width adjustment to accentuate differences in soft-tissue density. The arrow demonstrates a subtle abnormality in the pancreas.

Case Description

A 17-year-old woman was admitted to the hospital with a history of hypoglycemia and a seizure.

Fig 1 shows a computed tomography (CT) scan of the abdomen through the level of the pancreas. The scan was performed with contrast administration and spiral acquisition. Fig 2 represents the same axial scan but with a narrower window-width adjustment to accentuate differences in soft-tissue density. The arrow demonstrates a subtle abnormality in the pancreas.

Which of the following choices is the most likely diagnosis?

1. cystic mass in the head of the pancreas

2. hypovascular mass in the tail of the pancreas

3. insulinoma

4. cystadenocarcinoma of the pancreas

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Turn to the next page for the answer and discussion.

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