The findings here are consistent with a mixed-type IPMN. There is continuous dilatation of the entire main pancreatic duct, with a column of mucin extending into the ampulla of Vater, known as the fish mouth ampulla sign. High-risk features include dilatation of the pancreatic duct to greater than 10 mm. There are no nodules detected within the duct wall. Minimal dilatation of the side branches is appreciated only on the heavily T2 weighted on the MRI study. Some edema of the head and neck of the gland is consistent with mild acute pancreatitis related to the underlying disease process. Imaging appearances have stayed stable on serial imaging studies while surgery is awaited.