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AJR Teaching File: Chronic Nausea and Vomiting with Abdominal Pain

Jeremy L. Friese1 and Amy K. Hara2

1 Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN.
2 Department of Diagnostic Radiology, Mayo Clinic Scottsdale, 13400 E Shea Blvd., Scottsdale, AZ 85259.


Figure 1
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  		Fig. 1A —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Upper gastrointestinal image shows mild narrowing of second portion of duodenum (arrow).

 

Figure 2
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  		Fig. 1B —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Contrast-enhanced CT scans show pancreatic tissue abnormally located laterally in relation to descending duodenum (D), consistent with annular pancreas. Note cystic mass (arrowhead, D and E) in pancreatic head that communicates with mildly dilated main pancreatic duct and dilated duct in annular portion of pancreas.

 

Figure 3
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  		Fig. 1C —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Contrast-enhanced CT scans show pancreatic tissue abnormally located laterally in relation to descending duodenum (D), consistent with annular pancreas. Note cystic mass (arrowhead, D and E) in pancreatic head that communicates with mildly dilated main pancreatic duct and dilated duct in annular portion of pancreas.

 

Figure 4
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  		Fig. 1D —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Contrast-enhanced CT scans show pancreatic tissue abnormally located laterally in relation to descending duodenum (D), consistent with annular pancreas. Note cystic mass (arrowhead, D and E) in pancreatic head that communicates with mildly dilated main pancreatic duct and dilated duct in annular portion of pancreas.

 

Figure 5
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  		Fig. 1E —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Contrast-enhanced CT scans show pancreatic tissue abnormally located laterally in relation to descending duodenum (D), consistent with annular pancreas. Note cystic mass (arrowhead, D and E) in pancreatic head that communicates with mildly dilated main pancreatic duct and dilated duct in annular portion of pancreas.

 

Figure 6
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  		Fig. 1F —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. MR images show findings similar to CT. Annular duct is not well visualized on 3D MR cholangiopancreatography (MRCP) image (G). Arrowhead in G indicates cystic mass.

 

Figure 7
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  		Fig. 1G —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. MR images show findings similar to CT. Annular duct is not well visualized on 3D MR cholangiopancreatography (MRCP) image (G). Arrowhead in G indicates cystic mass.

 

Figure 8
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  		Fig. 1H —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. ERCP image shows normal-appearing pancreatic duct; annular portion is not seen.

 

Figure 9
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  		Fig. 1I —67-year-old woman with worsening chronic nausea, vomiting, and abdominal pain. Surgical pathology confirms intraductal papillary mucinous neoplasm in annular pancreas. Photograph from gross pathology shows annular portion of pancreas (arrows) and dilated duct surrounding duodenum. Duct in annular portion was not seen on MRCP or ERCP because of obstructing mucin.

 

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