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Duodenal Diverticula Mimicking Cystic Neoplasms of the Pancreas: CT and MR Imaging Findings in Seven Patients

¹ All authors: Department of Radiology, Abdominal Imaging Section, Tisch Hospital, New York University Medical Center, 560 First Ave., Ste. HW 207, New York, NY 10016.

View larger version (144K): [in a new window]   Fig. 1A. —Duodenal diverticulum in 45-year-old woman. Axial CT scan obtained with IV and oral contrast materials at level of pancreatic head shows 10-mm cystic process with curvilinear area of increased attenuation (long arrow) that was initially thought to represent intraductal papillary mucinous tumor. Short arrow identifies duodenum.

View larger version (181K): [in a new window]   Fig. 1B. —Duodenal diverticulum in 45-year-old woman. Follow-up axial CT scan obtained at same level as A 12 months later shows intradiverticular gas (arrow), confirming diagnosis of duodenal diverticulum.

View larger version (149K): [in a new window]   Fig. 1C. —Duodenal diverticulum in 45-year-old woman. Spot radiograph from upper gastrointestinal barium series shows characteristic appearance of duodenal diverticulum (arrow).

View larger version (148K): [in a new window]   Fig. 2A. —Duodenal diverticulum in 85-year-old man. Axial CT scan obtained with IV and oral contrast materials at level of pancreatic head shows 15-mm fluid-filled cystic process (long arrow) that was initially thought to represent nonspecific cystic pancreatic tumor. Short arrow identifies duodenum.

View larger version (151K): [in a new window]   Fig. 2B. —Duodenal diverticulum in 85-year-old man. Follow-up axial CT scan obtained at similar level as A 6 months later shows complete filling of diverticulum with gas (arrow), confirming diagnosis of duodenal diverticulum.

View larger version (148K): [in a new window]   Fig. 3A. —Duodenal diverticulum in 75-year-old man. Axial T2-weighted MR image obtained with HASTE sequence (TR/TE, infinite/67; flip angle, 150°) shows 25-mm cystic process (long arrow) in region of pancreatic head. Along ventral aspect of cystic process is focus of low signal intensity (arrowhead) that likely represents small amount of gas but was not identified as such. Note dilated pancreatic duct (short arrow) resulting from incidental polyp (not visualized) in distal common bile duct. Duodenal diverticulum was initially thought to represent mucinous cystic tumor.

View larger version (157K): [in a new window]   Fig. 3B. —Duodenal diverticulum in 75-year-old man. Axial CT scan obtained at same level as A 1 week later shows filling of diverticulum with gas and fluid (arrow), confirming diagnosis of duodenal diverticulum.

View larger version (143K): [in a new window]   Fig. 4A. —Duodenal diverticulum in 54-year-old woman. Axial T2-weighted MR image obtained with HASTE sequence (TR/TE, infinite/67; flip angle, 150°) shows 15-mm cystic process (long thick arrow) in region of pancreatic head that was initially thought to represent intraductal papillary mucinous neoplasm. Along lateral aspect of cystic process is focus of low signal intensity (long thin arrow) that likely represents small amount of gas but was not initially interpreted as such. Note second cystic area (short thick arrow) just dorsal relative to cystic process; this area was initially thought to represent third portion of duodenum.

View larger version (145K): [in a new window]   Fig. 4B. —Duodenal diverticulum in 54-year-old woman. Follow-up axial CT scan obtained 6 months later at same level as A with oral and IV contrast materials at outside institution shows filling of diverticulum (arrow) with gas and barium, confirming presence of duodenal diverticulum with bilobal configuration.

View larger version (166K): [in a new window]   Fig. 5A. —Duodenal diverticulum in 54-year-old woman. Axial T2-weighted MR image obtained with HASTE sequence (TR/TE, infinite/67; flip angle, 150°) shows 15-mm cystic process (arrow) in region of pancreatic head.

View larger version (179K): [in a new window]   Fig. 5B. —Duodenal diverticulum in 54-year-old woman. Coronal T2-weighted MR image obtained with HASTE sequence (infinite/67; flip angle, 150°) shows 15-mm cystic process (long arrow) in region of pancreatic head. Main pancreatic duct (short arrow) and common bile duct (arrowhead) are shown entering cystic process. This finding was initially thought to represent nonspecific cystic pancreatic neoplasm.

View larger version (159K): [in a new window]   Fig. 5C. —Duodenal diverticulum in 54-year-old woman. Axial CT scan obtained 6 months earlier at same level as A with oral and IV contrast material shows filling of diverticulum (arrow) with gas and barium, confirming presence of duodenal diverticulum.

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