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Pancreas: Imaging Approach and Differential Diagnosis

Embryology and Normal Variants The body-tail segment of the pancreas develops from the embryologic dorsal pancreatic bud, while the head-uncinate segments develop from the ventral bud, which also gives rise to the liver and biliary tree. During normal development, the ventral bud migrates clockwise around the fetal duodenum and eventually merges with the dorsal bud to form the pancreas with the branching pancreatic and biliary ducts…

Biliary IPMN

KEY FACTS Terminology Mucin-producing papillary neoplasm of biliary mucosa Analogous to pancreatic intraductal papillary mucinous neoplasm in imaging and pathology Overlap with biliary papillomatosis (same entity?) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Biliary Papillomatosis

KEY FACTS Terminology Rare disorder characterized by multiple adenomatous papillary tumors of biliary tree May be same entity as biliary intraductal papillary mucinous neoplasm (IPMN) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Imaging and Management of Biliary Injuries

KEY FACTS Imaging Biliary injuries are increasing in frequency Imaging plays crucial role in identification & management Direct Cholangiography ERCP is best for evaluation of injury to major hepatic duct branches & CBD – Also guides therapeutic intervention (sphincterotomy & stent placement) CT : Accurately depicts presence and extent of hepatic parenchymal injuries Active bleeding is accurately depicted Hepatic arterial (HA) occlusion may be depicted or…

Chemotherapy-Induced Cholangitis

KEY FACTS Terminology Chemotherapy-induced sclerosing cholangitis (or biliary sclerosis) Iatrogenic cholangitis following intraarterial chemotherapy for hepatic malignancies Imaging MR with MRCP is best imaging test Segmental strictures of variable length (similar to those seen in primary sclerosing cholangitis) Strictures of common hepatic and larger intrahepatic ducts Frequently involves common hepatic duct and biliary confluence but not distal common bile duct Ductal abnormalities may include Duct wall…

Mirizzi Syndrome

KEY FACTS Terminology Partial or complete obstruction of common hepatic duct (CHD) due to gallstone impaction in cystic duct, infundibulum, or Hartmann pouch of gallbladder (GB) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Gallstones and Choledocholithiasis

KEY FACTS Terminology Gallstones: Concretions within biliary system [gallbladder (GB) and biliary ducts] Cholesterol stones (75-80%) Pigment stones (20-25%) – "Black" stones in sterile GB; small; common in cirrhosis and hemolytic states – "Brown" stones in infected bile (e.g., recurrent pyogenic cholangitis) Sludge: Suspension of particulate material, crystals, and bile within GB Choledocholithiasis: Presence of stones in common bile duct (CBD); usually originate in GB Imaging…

Recurrent Pyogenic Cholangitis

KEY FACTS Terminology Repeated bouts of cholangitis, intra- and extrahepatic biliary ductal dilatation, and biliary calculi, typically in inhabitants of or immigrants from Southeast Asia You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here