Radiological Reasoning: 88-Year-Old Man With Abdominal Pain and Dilated Biliary Tree and Pancreatic Duct

Department of Radiology and Biomedical Imaging, Abdominal Imaging Division, University of California, San Francisco, 505 Parnassus Ave., Box 0628, M-372, San Francisco, CA 94143-0628, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 06/2010; 194(6 Suppl):S46-50. DOI: 10.2214/AJR.07.7058
Source: PubMed


Objective Marked intra- and extrahepatic biliary ductal dilatation and a questionable pancreatic mass were incidentally discovered on CT of an 88-year-old man. The most important diseases to be considered in this case scenario are pancreatic adenocarcinoma, ampullary carcinoma, intraductal papillary mucinous neoplasm (IPMN), and chronic pancreatitis. We will focus our review on the dilatation of the biliary and pancreatic ducts and assess each entity separately. Conclusion In patients with IPMN, findings that suggest malignancy include the presence of mural nodules, especially those measuring 5 mm or more in diameter; thickened and irregular cyst walls or septa; marked diffuse dilatation of the main pancreatic duct; and ductal diameter equal to or greater than 30 mm.

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