Presentation
The patient presented with nausea, malaise, and abdominal cramping. There is a background history of cystic fibrosis with a double-lung transplant four years prior.
Patient Data
2.4 x 2.4 cm cystic structure in the region of the pancreatic head, interposed between the superior mesenteric vessels and the common bile duct. There is a separate sub-centimeter cystic focus in the expected region of the pancreatic tail. Complete fatty replacement of the pancreatic parenchyma.
Mild dilatation of the intrahepatic bile ducts in the left lobe of the liver.
There is a complete fatty replacement in the pancreatic parenchyma. In the expected region of the pancreatic head, there is a multiloculated cystic structure measuring 4 x 2.5 x 2.5 cm. Some T2 hypointense cyst contents are layering posteriorly, likely to represent proteinaceous or hemorrhagic material. A further small, simple-appearing cyst is noted in the expected region of the pancreatic tail.
Additionally, two stones are in the left hepatic duct adjacent to the portal confluence. This results in mild intrahepatic biliary ductal dilatation in the left lobe of the liver, with atrophy of the left lobe likely related to chronic biliary obstruction.
Case Discussion
This patient demonstrates many of the reported abdominal manifestations of cystic fibrosis. These include fatty replacement of the pancreatic parenchyma, the development of multiple macroscopic cysts (pancreatic cystosis), and gallstones. Layering cyst contents, in this case, is not typical but has been reported in pancreatic cystosis 1.
In this case, the patient's symptoms may have been secondary to intra-hepatic choledocholithiasis, and the presence of pancreatic cystosis was likely incidental.
The case was provided courtesy of Dr. Brian Gibney, Mater Misericordiae University Hospital, Dublin.
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