To study the first symptoms and signs of enhanced CT imaging in the elderly patients with pancreatic cancer in order to improve the awareness of pancreatic cancer in the elderly. Methods A retrospective analysis was carried out on 65 patients with pancreatic cancer confirmed by pathology admitted in our hospital from February 2014 to December 2021. According to their age, they were assigned into an elderly group (≥60 years old, n=43) and a middle-aged group (aged from 45 to 59 years, n=22). The characteristics of elderly patients with pancreatic cancer were summarized. The clinical first symptoms and signs of enhanced CT imaging were compared and analyzed between the two groups. SPSS statistics 22.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test or χ² test depending on data type. Results A total of 65 patients with pancreatic cancer were included in this study, including 43 cases (66.2%) in the elderly group and 22 cases (33.8%) in the middle-aged group. The incidences of tumor in the pancreatic head, jaundice, emaciation and pancreatic duct dilatation in the elderly group were 51.2% (22/43), 55.8% (24/43), 53.5% (23/43) and 58.1% (25/43), respectively, which were significantly higher than those in the middle-aged group [27.3% (6/22), 13.6% (3/22), 27.3% (6/22) and 27.3% (6/22), all P<0.05]. The rates of tumor in the pancreatic tail, abdominal pain, abdominal tenderness and liver metastasis were 9.3% (4/43), 32.6% (14/43), 44.2% (19/43) and 23.3% (10/43), respectively in the elderly group, obviously lower than those in the middle-aged group [40.9% (9/22), 63.6% (14/22), 72.7% (16/22) and 50.0% (11/22), all P<0.05]. There were no statistical differences in other indicators between the 2 groups. Conclusion Elderly pancreatic cancer has certain characteristics. Combining its clinical manifestations and imaging signs can improve the accuracy of diagnosis.