Pancreatic malignancy in disguise: imaging pitfalls and mimickers of pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy and continues to rank among the leading causes of cancer-related death worldwide. Imaging plays a central role in detection, staging, and treatment planning; nevertheless, PDAC remains one of the most frequently missed or misdiagnosed abdominal malignancies in clinical practice. Diagnostic challenges arise from subtle early imaging findings, anatomic blind spots within the pancreas, and a wide spectrum of inflammatory, benign, and malignant entities that closely mimic PDAC, such as focal acute pancreatitis, mass-forming chronic pancreatitis, autoimmune pancreatitis, groove pancreatitis, neuroendocrine tumors, lymphoma, metastases, solid pseudopapillary neoplasms and focal fatty infiltration. This narrative review provides a comprehensive, imaging-focused discussion of PDAC and its mimickers, with an emphasis on practical problem-solving strategies to reliably differentiate mimics from PDAC and improve diagnostic confidence, reduce unnecessary interventions, and facilitate timely and appropriate patient management.