Atypical manifestations of pancreatitis with autoimmune phenomenon in an adolescent female.
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We report a case of an adolescent girl with atypical manifestations of pancreatitis with autoimmune phenomenon presenting with epigastralgia and back pain. While no abnormalities were detected on computed tomography and magnetic resonance imaging, apart from the absence of peripancreatic spread, laboratory and serological findings, such as hypergammaglobulinemia, a high titer of immunoglobulin G, a high titer of immunoglobulin G4, slight positivity for antinuclear antibodies, and positivity for autoantibodies to lactoferrin, were suggestive of autoimmune pancreatitis (AIP). Magnetic resonance cholangiopancreatography imaging (MRCP) visualized only the main pancreatic duct (MPD) in the pancreas head region. Proteoclastic enzyme inhibitor treatment was ineffective but the patient responded well to oral prednisolone. The patient and her family did not consent to endoscopic retrograde pancreatography or biopsy/histopathological examination. The case could not be diagnosed as AIP due to lack of typical diagnostic criteria, and thus the final diagnosis was considered pancreatitis with autoimmune phenomenon. We considered that the MRCP finding of partly visible MPD was due to diffuse irregular narrowing of the MPD. This case suggests that while MRCP imaging of the MPD may be helpful in the diagnosis of pancreatitis with autoimmune phenomenon, a negative result does not preclude such diagnosis. (+info)
Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones.
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INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) is a safe and sensitive investigation for the imaging of common bile duct pathology. When used to exclude common bile duct (CBD) stones, MRCP may obviate the need for intra-operative cholangiogram (IOC). In this prospective study, we looked at the single centre results of patients who underwent cholecystectomy with IOC following pre-operative MRCP. PATIENTS AND METHODS: Over a period of 18 months, 69 patients (24 male and 45 female; mean age 59 years [range, 19-86 years]) were investigated by MRCP prior to cholecystectomy. All patients underwent IOC. Inclusion criteria for MRCP consisted of derangement of liver function tests and/or history of jaundice in cases of ultrasound-proven cholelithiasis. RESULTS: Sixteen patients had suspected stones or filling defects on MRCP; all but two of these were confirmed to be stones on IOC. In only one patient was a stone visualised on IOC and not seen on MRCP. CONCLUSION: MRCP may be the only pre-operative investigation needed for exclusion of CBD stones, obviating the necessity for IOC. (+info)
Diagnostic accuracy of MRI for preoperative staging of pancreatic carcinoma: tendency for understaging.
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OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for preoperative staging in pancreatic carcinoma. MATERIALS AND METHODS: MRI investigations, including MR-angio and MR-cholangiopancreatography (MRCP) of 19 patients who underwent surgery for pancreatic carcinoma were retrospectively evaluated by two radiologists. The size, localization of the tumor and possible infiltration of neighboring organs, as well as the presence of enlarged lymph nodes, were determined to define a preoperative, radiological TN stage. Lymph node metastasis was defined as peripancreatic lymphoma greater than 10 mm. Our findings were correlated to postoperative diagnosis. RESULTS: The T-stage was correctly evaluated in 52.6% of the cases (10/19). Understaging took place in 31.6% (6/19) and overstaging in 15.8% (3/19). In three cases of understaging, a micro-infiltration of the peripancreatic tissue was not visible in MRI. Pathologically enlarged lymph nodes were correctly found in 63.2% of the cases (12/19). Overstaging took place in 21.1% of the cases (4/19) and understaging in 15.8% (3/19). CONCLUSION: MRl for preoperative staging of pancreatic carcinoma showed a tendency to understage tumor size in this study population. Especially in cases of small tumor size, micro-infiltration of peripancreatic tissue or the common bile duct may not be detected by MRI. Concerning N-stage, the 95% confidence interval reveals a distribution of over- and understaged. (+info)
PURPOSE: To present MR cholangiopancreatography (MRCP) findings and to determine the hepatic morphological changes of primary sclerosing cholangitis (PSC) seen on T2-weighted fast spin echo (FSE) images. MATERIALS AND METHODS: Twenty-three patients (15 women, 8 men) with ages ranging from 17 to 80 years (median, 45.1 years) were included in the study. MR imaging was performed on a 1 Tesla MR unit using a phased-array coil. Heavily T2-weighted images were obtained with single-shot fast spin echo technique for MRCP. Morphological changes encountered in livers were evaluated with coronal and axial T2-weighted fast spin echo images. RESULTS: Irregularities, multifocal strictures, and dilatations in different levels of the biliary channels were seen in all patients. T2-weighted images showed lobulated hepatic contours in 21.73%, atrophy in both anterior and posterior segments of the right lobe in 21.73%, atrophy in the anterior segment in 13.04%, atrophy in both medial and lateral segments of the left lobe in 17.39%, atrophy in the medial segment in 8.69%, atrophy in the lateral segment in 4.34%, hypertrophy in the posterior segment of the right lobe in 4.34%, global hypertrophy in the left lobe in 4.34%, hypertrophy in the lateral segment of the left lobe in 4.34%, and caudate lobe hypertrophy in 21.73% of the patients. In addition, periportal edema was noted in 39.13%, increased parenchymal signal on T2-weighted images in 26.08%, periportal and/or portocaval lymphadenopathy in 34.78%, and portal hypertension in 34.78% of our patients. In one patient (4.34%), the liver had a round shape characteristic of PSC. CONCLUSION: MR imaging is a useful method for establishing the changes in biliary ducts specific to PSC, and for identifying long-standing cases complicated with cirrhosis. (+info)
MR cholangiopancreatography of a case with a biliary tract variation and postoperative biliary duct injury.
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Because of the increasing frequency of surgical procedures such as hepatic resection, partial liver transplantation, and laparoscopic cholecystectomy, the number of patients requiring biliary imaging has increased. In this report, magnetic resonance cholangiopancreatography findings of a case with an aberrant right posterior hepatic duct draining directly into the gallbladder, which was overlooked prior to laparoscopic cholecystectomy, is presented and the importance of magnetic resonance cholangiopancreatography in the evaluation of congenital biliary anomalies and iatrogenic bile duct injury is discussed. (+info)
Acute pancreatitis associated with neuroendocrine tumor of the pancreas.
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CONTEXT: Endocrine tumors are a less commonly known cause of acute pancreatitis. This report presents the case of a patient who have had acute pancreatitis secondary to a pancreatic endocrine neoplasm. The majority of the cases previously reported were non-functioning tumors and the pancreatitis tended to be mild. Moreover, the majority of the tumors were diagnosed in advanced stages, hindering curative treatment. CASE REPORT: A 31-year-old female patient presented with epigastric pain and a history of recurrent acute pancreatitis. Preoperative imaging investigation showed a dilation of the distal portion of the main pancreatic duct and intra-operative ultrasound demonstrated a mild stricture of the main pancreatic duct at the body of the pancreas. Frozen-section examination revealed a malignant neoplasm, subsequently identified as a neuroendocrine carcinoma, and a distal pancreatectomy with splenectomy was performed. Acute pancreatitis was an early symptom in this patient who underwent a hopefully curative resection. CONCLUSION: The authors conclude that, in patients with acute pancreatitis of unknown origin, the possibility of a non-functioning neuroendocrine tumor should be investigated. (+info)
Involvement of pancreatic and bile ducts in autoimmune pancreatitis.
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AIM: To examine the involvement of the pancreatic and bile ducts in patients with autoimmune pancreatitis. METHODS: Clinical and cholangiopancreatographic findings of 28 patients with autoimmune pancreatitis were evaluated. For the purposes of this study, the pancreatic duct system was divided into three portions: the ventral pancreatic duct; the head portion of the dorsal pancreatic duct; and the body and tail of the dorsal pancreatic duct. RESULTS: Both the ventral and dorsal pancreatic ducts were involved in 24 patients, while in 4 patients only the dorsal pancreatic duct was involved. Marked stricture of the bile duct was detected in 20 patients and their initial symptom was obstructive jaundice. Six patients showed moderate stenosis to 30%-40% of the normal diameter, and the other two patients showed no stenosis of the bile duct. Although marked stricture of the bile duct was detected in 83% (20/24) of patients who showed narrowing of both the ventral and dorsal pancreatic ducts, it was not observed in the 4 patients who showed involvement of the dorsal pancreatic duct alone (P=0.0034). CONCLUSION: Both the ventral and dorsal pancreatic and bile ducts are involved in patients with autoimmune pancreatitis. (+info)
Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings.
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We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas. (+info)