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Congenital Anomalies and Normal Variants of the Pancreaticobiliary Tract and the Pancreas in Adults: Part 2, Pancreatic Duct and Pancreas

Jinxing Yu1, Mary Ann Turner1, Ann S. Fulcher1 and Robert A. Halvorsen1

1 All authors: Department of Radiology, VCU Health Systems, Virginia Commonwealth University, 1250 E Marshall St., Richmond, VA 23298-0615.


Figure 1
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  		Fig. 1A —Diagram of pancreatic ductal anatomic variants. Main pancreatic duct joining common bile duct drains via major papilla.

 

Figure 2
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  		Fig. 1B —Diagram of pancreatic ductal anatomic variants. Main pancreatic duct drains via major papilla. Accessory duct (duct of Santorini) (open arrow) is patent and drains via minor papilla.

 

Figure 3
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  		Fig. 1C —Diagram of pancreatic ductal anatomic variants. Typical pancreatic divisum with small ventral duct (arrows) drains via major papilla. Larger dorsal duct (open arrows) drains via minor papilla.

 

Figure 4
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  		Fig. 2 —48-year-old woman with liver disease. Coronal MR cholangiopancreatography (MRCP) thick-slab image shows main pancreatic duct (DP) entering minor papilla (arrowhead) in duodenum without joining with common bile duct (CBD). Point of entry is cephalad to major papilla (open arrow). Common bile duct (CBD) joins with ventral pancreatic duct (VP) and both enter major papilla. There is no communication between dorsal duct (DP) and ventral duct (VP). Gallbladder (GB) is noted.

 

Figure 5
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  		Fig. 3 —63-year-old woman with congestive heart failure and abdominal pain. Axial CT image shows main pancreatic duct (DP) running anteriorly and parallel to common bile duct (open arrow). Ventral duct (VP) joins bile duct before entering duodenum (D). Pancreas (P) is noted.

 

Figure 6
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  		Fig. 4A —44-year-old woman with recurrent pancreatitis. Coronal MR cholangiopancreatography (MRCP) thin-slab image shows dilated dorsal pancreatic duct (DP) entering duodenum (D) without joining common bile duct (CBD). Point of entry of dorsal pancreatic duct is cephalad and anterior to major papilla. Pancreatic ductal side branch ectasia (open arrow) and small pseudocysts (arrowheads) are noted, consistent with chronic pancreatitis. Gallbladder (GB) is noted.

 

Figure 7
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  		Fig. 4B —44-year-old woman with recurrent pancreatitis. Coronal MRCP thin-slab image posterior to A shows common bile duct (CBD) and dilated ventral duct (VP) entering major papilla (arrow) in duodenum (D). Dilated pancreatic duct in pancreatic tail (DP) is present. Gallbladder (GB) is noted.

 

Figure 8
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  		Fig. 5A —Diagram of annular pancreas. Frontal view shows pancreatic tissue (arrows) encircling descending duodenum.

 

Figure 9
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  		Fig. 5B —Diagram of annular pancreas. Axial view shows pancreatic tissue (open arrows) with accessory pancreatic duct (arrows) encircling duodenum.

 

Figure 10
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  		Fig. 6A —23-year-old man with elevated pancreatic enzymes after trauma. Axial CT image shows large pseudocyst (C) in pancreas (P) consistent with pancreatic injury. Pancreatic tissue (arrows) completely surrounds descending duodenum (D).

 

Figure 11
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  		Fig. 6B —23-year-old man with elevated pancreatic enzymes after trauma. Coronal MR cholangiopancreatography (MRCP) thin-slab image shows pancreatic duct (arrows) in pancreatic tissue adjacent to lateral wall of descending duodenum (D). Common bile duct (CBD) is noted.

 

Figure 12
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  		Fig. 6C —23-year-old man with elevated pancreatic enzymes after trauma. ERCP image shows pancreatic duct (P) making loop in its proximal portion. Loop (arrows) of pancreatic duct encircles second portion of duodenum (D). Common bile duct (CBD) is noted.

 

Figure 13
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  		Fig. 7A —51-year-old woman with leukemia. Axial CT image shows pancreatic tissue (P) and pancreatic duct (arrows) encircling descending duodenum (D). Common bile duct (CBD) and gallbladder (GB) are noted.

 

Figure 14
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  		Fig. 7B —51-year-old woman with leukemia. Axial CT image superior to A shows pancreatic tissue (P) and pancreatic duct (arrows) extending lateral to descending duodenum (D). Gallbladder (GB) are noted.

 

Figure 15
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  		Fig. 7C —51-year-old woman with leukemia. Image from upper gastrointestinal series shows extrinsic defect (solid arrows) with focal narrowing (open arrows) of descending duodenum (D). Stomach (S) and jejunum (J) are noted.

 

Figure 16
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  		Fig. 8 —23-year-old man with upper abdominal pain. Image from upper gastrointestinal series shows extramucosal, smooth filling defect (solid arrows) in gastric antrum (A). Central umbilication (open arrow) is present within lesion. Endoscopy confirmed diagnosis of ectopic pancreas. Duodenum (D) is noted.

 

Figure 17
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  		Fig. 9A —31-year-old man with abnormal results of liver function test. Axial CT image shows soft-tissue attenuation focus (arrows) arising from pancreas (P) that is similar in attenuation to tissue in pancreatic head (P).

 

Figure 18
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  		Fig. 9B —31-year-old man with abnormal results of liver function test. T1-weighted axial unenhanced fat-suppressed image shows that soft-tissue protuberance (arrows) is isointense to pancreatic head (P). Enhanced images (not shown) revealed that protuberance enhanced in fashion identical to pancreatic head.

 

Figure 19
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  		Fig. 9C —31-year-old man with abnormal results of liver function test. Coronal MR cholangiopancreatography (MRCP) image shows branch (arrows) of pancreatic duct (P) in soft-tissue protuberance that drains into main pancreatic duct. Common bile duct (CBD) and duodenum (D) are noted. These findings are indicative of contour anomaly of pancreas.

 

Figure 20
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  		Fig. 10A —45-year-old man with primary sclerosing cholangitis. T1-weighted axial MR image shows prominent lateral contour (arrows) of pancreatic head (P). Duodenum (D) is noted.

 

Figure 21
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  		Fig. 10B —45-year-old man with primary sclerosing cholangitis. T1-weighted axial MR image inferior to A shows prominent lateral contour (arrows) of pancreatic head (P). Duodenum (D) is noted.

 

Figure 22
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  		Fig. 11A —62-year-old woman with possible mass in pancreatic head seen on chest CT. Axial CT scan shows focal fatty infiltration (arrows) in pancreatic head. There is fat sparing in pancreatic neck (P). Duodenum (D) is noted.

 

Figure 23
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  		Fig. 11B —62-year-old woman with possible mass in pancreatic head seen on chest CT. In-phase T1-weighted axial image shows high signal intensity in pancreatic head (arrows).

 

Figure 24
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  		Fig. 11C —62-year-old woman with possible mass in pancreatic head seen on chest CT. Out-of-phase T1-weighted axial image shows significant signal decrease in pancreatic head (arrows) consistent with focal fatty infiltration.

 

Figure 25
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  		Fig. 12 —36-year-old woman with cystic fibrosis. Axial CT scan shows complete fatty replacement of pancreas (arrows) anterior to splenic vein (V). Liver (L) is noted. Splenic vein enlargement and splenomegaly (Sp) are manifestations of portal hypertension.

 

Figure 26
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  		Fig. 13 —47-year-old woman with von Hippel-Lindau syndrome. Axial CT scan shows multiple cysts (arrows) within pancreas (P). Liver (L) is noted.

 

Figure 27
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  		Fig. 14A —32-year-old woman with abdominal pain. Coronal T2-weighted MR image shows bifid pancreatic duct (arrows) in body of pancreas. Duodenum (D) is noted.

 

Figure 28
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  		Fig. 14B —32-year-old woman with abdominal pain. ERCP image confirms presence of bifid pancreatic duct (arrows). Duodenum (D) is noted.

 

Figure 29
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  		Fig. 15 —52-year-old man with cirrhosis. Coronal thick-slab MR cholangiopancreatography (MRCP) image shows loop (arrows) of pancreatic duct in pancreatic head. Common bile duct (CBD), pancreatic duct (P), and duodenum (D) are noted.

 

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