EURORAD ESR

Case 14844

Lithiasis of main pancreatic duct in idiopathic chronic pancreatitis

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 63 year(s)
 
 
  • Figure 1
    Unenhanced and post-contrast multidetector CT
     

    Precontrast images viewed at bone window settings showed a 1.5cm calcification (black arrow) at the site of the Vaterian ampulla, with strong homogeneous hyperattenuation (average±standard deviation 2600±45...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    The portal-venous enhanced acquisition confirmed a 1.5cm dense calcification (black arrows) at the site of the Vaterian ampulla. Note normal-appearing gallbladder, absent peripancreatic fluid.

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Oblique (c) and curved (d) planar reformations showed the intraductal location of the dense calcification (black arrows) and the marked upstream dilatation (maximum 9 mm) of the main pancreatic duct (MPD, arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Oblique (c) and curved (d) planar reformations showed the intraductal location of the dense calcification (black arrows) and the marked upstream dilatation (maximum 9 mm) of the main pancreatic duct (MPD, arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Several smaller, mostly tiny pancreatic calcifications (thin arrows) were present, particularly in the head. Note dense MPD stone (black arrow in e), dilated upstream MPD (arrowheads) with parenchymal atrophy along...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Several smaller, mostly tiny pancreatic calcifications (thin arrows) were present, particularly in the head. Note dense MPD stone (black arrow in e), dilated upstream MPD (arrowheads) with parenchymal atrophy along...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;
     
     
  • Figure 2
    MR-cholangiopancreatography (MRCP)
     

    Axial (a) and coronal (b) T2-weighted images confirmed low-signal stone (black arrow) at termination of MPD, surrounded by intraductal hyperintense fluid. Note normal-appearing gallbladder, absent peripancreatic fluid.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Axial (a) and coronal (b) T2-weighted images confirmed low-signal stone (black arrow) at termination of MPD, surrounded by intraductal hyperintense fluid. Note normal-appearing gallbladder, absent biliary obstruction.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    MRCP images (c,d) confirmed dilated MPD (arrowheads), distally obstructed by the strongly hypointense intraductal stone (arrows). Note normal-appearing intrahepatic and common bile ducts.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Calcifications / Calculi;

    MRCP images (c,d) confirmed dilated MPD (arrowheads), distally obstructed by the strongly hypointense intraductal stone (arrows). Note normal-appearing intrahepatic and common bile ducts.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Calcifications / Calculi;

    Additionally, T2-weighted images (e,f) confirmed pancreatic atrophy with marked parenchymal thinning along neck, body and tail, surrounding the dilated MPD (arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Additionally, T2-weighted images (e,f) confirmed pancreatic atrophy with marked parenchymal thinning along neck, body and tail, surrounding the dilated MPD (arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;
     
     
  • Figure 3
    Endoscopic ultrasound (EUS) and attempted endoscopic treatment
     

    EUS images (a, b) confirmed hyperechoic intraductal stone (arrows) of distal MPD, causing posterior shadowing (in a).

     
    Area of Interest: Pancreas; Imaging Technique: Ultrasound; Procedure: Endoscopy; Special Focus: Calcifications / Calculi;

    EUS images (a, b) confirmed hyperechoic intraductal stone (arrows) and dilated upstream MPD (arrowhead in b).

     
    Area of Interest: Pancreas; Imaging Technique: Ultrasound; Procedure: Endoscopy; Special Focus: Calcifications / Calculi;

    Endoscopically, bulging of the Vaterian ampulla was seen, caused from radiographically dense stone (black arrows) which obstructed passage to guidewires (thick arrow).

     
    Area of Interest: Pancreas; Imaging Technique: Plain radiographic studies; Procedure: Endoscopy; Special Focus: Calcifications / Calculi;
     
     
Precontrast images viewed at bone window settings showed a 1.5cm calcification (black arrow) at the site of the Vaterian ampulla, with strong homogeneous hyperattenuation (average±standard deviation 2600±45 Hounsfield units). Note normal-appearing gallbladder, absent peripancreatic fluid.
 
The portal-venous enhanced acquisition confirmed a 1.5cm dense calcification (black arrows) at the site of the Vaterian ampulla. Note normal-appearing gallbladder, absent peripancreatic fluid.
 
Oblique (c) and curved (d) planar reformations showed the intraductal location of the dense calcification (black arrows) and the marked upstream dilatation (maximum 9 mm) of the main pancreatic duct (MPD, arrowheads).
 
Oblique (c) and curved (d) planar reformations showed the intraductal location of the dense calcification (black arrows) and the marked upstream dilatation (maximum 9 mm) of the main pancreatic duct (MPD, arrowheads).
 
Several smaller, mostly tiny pancreatic calcifications (thin arrows) were present, particularly in the head. Note dense MPD stone (black arrow in e), dilated upstream MPD (arrowheads) with parenchymal atrophy along neck, body and tail.
 
Several smaller, mostly tiny pancreatic calcifications (thin arrows) were present, particularly in the head. Note dense MPD stone (black arrow in e), dilated upstream MPD (arrowheads) with parenchymal atrophy along neck, body and tail.
 
Axial (a) and coronal (b) T2-weighted images confirmed low-signal stone (black arrow) at termination of MPD, surrounded by intraductal hyperintense fluid. Note normal-appearing gallbladder, absent peripancreatic fluid.
 
Axial (a) and coronal (b) T2-weighted images confirmed low-signal stone (black arrow) at termination of MPD, surrounded by intraductal hyperintense fluid. Note normal-appearing gallbladder, absent biliary obstruction.
 
MRCP images (c,d) confirmed dilated MPD (arrowheads), distally obstructed by the strongly hypointense intraductal stone (arrows). Note normal-appearing intrahepatic and common bile ducts.
 
MRCP images (c,d) confirmed dilated MPD (arrowheads), distally obstructed by the strongly hypointense intraductal stone (arrows). Note normal-appearing intrahepatic and common bile ducts.
 
Additionally, T2-weighted images (e,f) confirmed pancreatic atrophy with marked parenchymal thinning along neck, body and tail, surrounding the dilated MPD (arrowheads).
 
Additionally, T2-weighted images (e,f) confirmed pancreatic atrophy with marked parenchymal thinning along neck, body and tail, surrounding the dilated MPD (arrowheads).
 
EUS images (a, b) confirmed hyperechoic intraductal stone (arrows) of distal MPD, causing posterior shadowing (in a).
 
EUS images (a, b) confirmed hyperechoic intraductal stone (arrows) and dilated upstream MPD (arrowhead in b).
 
Endoscopically, bulging of the Vaterian ampulla was seen, caused from radiographically dense stone (black arrows) which obstructed passage to guidewires (thick arrow).
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version