A missing piece of pancreas

A 35-year-old man came for a second opinion because of a hepatic lesion noted by ultrasound at a local clinic. The physical examination was unremarkable. Abdominal ultrasound showed a 1.2 cm subcapsular hypoechoic area in segment VI of the liver on a background of increased echogenicity, which was confirmed to be focal fatty sparing on subsequent computed tomography (CT) study of the abdomen. CT imaging disclosed that the tail and a portion of the body of the pancreas were absent (Figure 1), while the head and uncinate process appear normal. The patient had been taking oral hypoglycemic agents because of diabetes mellitus for years. He denied any history of pancreatitis or surgery. Hypoplasia of the pancreas, also known as partial agenesis of the pancreas or, more commonly, congenital short pancreas, refers to embryological underdevelopment of the pancreatic parenchyma involving either ventral or dorsal anlage.1 Complete agenesis of the pancreas is fatal and extremely rare.1,2 Dorsal pancreatic agenesis, which is more common than its ventral counterpart,1,2 can be an isolated finding or concomitant with other congenital anomalies.1–3