Intraductal papillary mucinous neoplasm - main duct type

Case contributed by Associate Professor Natalie Yang

Patient Data

Age: Adult

Dilated pancreatic ducts, most prominent at the head region. 

Dilated common bile duct up to Ampulla of Vater with no hyperdense stones seen.

Mild intrahepatic biliary dilatation, notably at the left lobe with pneumobilia.

Cholecystectomy clips are noted.

Case Discussion

This case represents dilated pancreatic ducts and common bile duct with mild pneumobilia and no associated signs of pancreatitis. No signs of distal biliary obstruction with a hyperdense stone or pancreatic head / ampullary mass lesion.

These features are reflecting biliary obstruction at the level of the duodenal ampulla. Intraductal papillary mucinous neoplasms or tumors (IPMN) could be considered. Further assessment to confirm the diagnosis is needed by ERCP or MRCP. Main duct type carries a risk of malignant transformation.

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