Presentation
Male patient in his mid fourth decade of life with history of peptic ulcer disease, to rule out perforation.
Patient Data
Numerable (counted at least 6) hyperechoic and posteriorly shadowing foci of macro-millimeter diameters are visible within the pancreatic duct lumen right from the proximal to the distal intra luminal duct of Wirsung region. The mentioned duct is minimally dilated with anechoic fluid that peripherally outlines the intra-ductal materials.
Mapped out color flow study of the pancreas reveals selective positive twinkling artifacts confined mostly on the foci surfaces. The intra and the extra-hepatic biliary tree, and the rest of the abdominal visceral structures show no pathology.
Case Discussion
The pancreatic duct calculi measure up to 0.57 cm in diameters and the partially obstructed pancreatic duct itself, measures 0.34 cm (in the anterior-posterior diameter; at the level of the pancreatic body region). The accessory duct of Santorini is not dilated. No intra/extra-hepatic biliary duct ectasia. No obvious intra-abdominal fluids to suggest gastroduodenal perforations either.
Pancreatic duct calculi have often been attributed to chronic pancreatitis but if diffusely involving the pancreatic parenchyma, may be pathognomonic to post fibrotic changes. In this presentation, the twinkling artifacts positively points and makes the diagnosis more compatible with partially obstructive pancreatic duct stones with duct ectasia.