Presentation
Incidentally noted multiple pancreatic cystic lesions on ultrasonography.
Patient Data
Multiple (>10) cystic pancreatic lesions noted showing the following details:
- location: head, body and tail
- size: 3 mm up to 3.2 cm (the largest is in the head)
- wall (thickness/enhancement): thin/imperceptible, non-enhancing
- septa: thin
- solid nodules: absent
- communication with pancreatic duct: present
- main pancreatic duct: caliber= 1.5 mm, no segments of dilatation
- background pancreatic parenchyma: normal
- CBD: normal, no dilatation
- related adenopathies: absent
Case Discussion
The imaging features are those of multiple side-branch IPMNs. No main ductal involvement. Branch duct type of intraductal papillary neoplasms (IPMN) appear as small cystic lesions with a bunch of grapes appearance. The key to the diagnosis is to recognize a communication with the main duct. The only worrisome feature, in this case, is the largest cyst measuring >3 cm. No other high-risk stigmata.
Multifocal IPMN has increased risk of malignant transformation. Imaging features suggestive of that include:
increased size >3 cm
nodules >2 mm
enhancing nodules or septations
dilated main pancreatic duct
Case courtesy, Prof. Dr. Mohamed Eid, Professor of Radiology, Alexandria University, Egypt.
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