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Traumatic Disruption of the Pancreatic Duct

Diagnosis with MR Pancreatography

Jorge A. Soto1, Oscar Alvarez2, Felipe Múnera1, Nora L. Yepes3, Maria E. Sepúlveda3 and Juan M. Pérez1

1 Department of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Calle 64 x Kra. 51D, Medellín, Colombia.
2 Department of Gastroenterology, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.
3 Department of Pediatrics, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.



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  		Fig. 1A. —22-year-old man with pancreatic fracture resulting from motor vehicle collision. Axial fat-suppressed T1-weighted MR image shows normally hyperintense pancreatic parenchyma divided by fracture (curved arrow). Note peripancreatic fluid collection (straight arrow).

 


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  		Fig. 1B. —22-year-old man with pancreatic fracture resulting from motor vehicle collision. Axial fat-suppressed T2-weighted MR image shows peripancreatic fluid collection (straight arrow) and intrapancreatic collection (curved arrow) occupying space between gland fragments. Note apparent communication of duct in tail with fluid collection (open arrow).

 


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  		Fig. 1C. —22-year-old man with pancreatic fracture resulting from motor vehicle collision. MR cholangiopancreatogram obtained using three-dimensional fast spin-echo sequence (frontal maximum-intensity pixel projection reformation) shows slightly dilated duct in tail of gland (short arrow) and fluid collections (long arrows). Note normal common bile duct (open arrow).

 


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  		Fig. 1D. —22-year-old man with pancreatic fracture resulting from motor vehicle collision. Retrograde pancreatogram obtained on same day as A-C shows site of duct disruption (straight arrow) and contrast material accumulating in fluid collection (curved arrow). Duct segment located beyond fracture line is not visible.

 


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  		Fig. 2A. —15-year-old boy with upper abdominal trauma from bicycle crash. Helical CT (not shown) revealed pancreatic fracture and fluid collections. Patient underwent surgical exploration and drainage of fluid collections before MR imaging. Fat-suppressed T1-weighted axial MR image shows fracture in neck of pancreas (straight arrow), small residual fluid collection (curved arrow), and dilated pancreatic duct (open arrow).

 


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  		Fig. 2B. —15-year-old boy with upper abdominal trauma from bicycle crash. Helical CT (not shown) revealed pancreatic fracture and fluid collections. Patient underwent surgical exploration and drainage of fluid collections before MR imaging. Fat-suppressed T2-weighted axial MR image shows fracture site (straight arrow), fluid collection (curved arrow), and dilated pancreatic duct (open arrow).

 


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  		Fig. 2C. —15-year-old boy with upper abdominal trauma from bicycle crash. Helical CT (not shown) revealed pancreatic fracture and fluid collections. Patient underwent surgical exploration and drainage of fluid collections before MR imaging. MR cholangiopancreatogram obtained with three-dimensional fast spin-echo sequence (frontal maximum-intensity pixel projection reformation) shows peripancreatic fluid collection (curved arrow) and dilated duct in body and tail of gland (open arrow). Note drainage catheter located adjacent to fluid collection (straight arrow).

 


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  		Fig. 2D. —15-year-old boy with upper abdominal trauma from bicycle crash. Helical CT (not shown) revealed pancreatic fracture and fluid collections. Patient underwent surgical exploration and drainage of fluid collections before MR imaging. Retrograde pancreatogram obtained 1 day after A-C confirms site of duct disruption (arrowhead) and shows contrast material accumulating in small fluid collection (curved arrow) as well as in surgically placed drain (straight arrow). However, dilated segment of duct was not depicted on retrograde imaging.

 

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