1/8. Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography.BACKGROUND: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. methods: We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. RESULTS: In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. CONCLUSION: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancrease should be carefully diagnosed in combination with CT.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/8. Bilo-pancreatic ascaris lumbricoides infestation. Endoscopic discovery and removal.ascaris lumbricoides infestation is relatively rare in industrialized countries, and it occurs mainly in conditions in which hygiene is lacking. We describe here a case of a 39-year-old female from ex-Jugoslavia affected by recurrent hepatic colic. At entry ultrasonography revealed microlithiasis in the gallbladder and widening of the pancreatic head. The subsequent ERCP showed slight filling defects in the choledochus and an inflammation-like stricture of the papilla of Vater, and after endoscopic sphincterotomy we saw an outflow of dense bile and microlitholits. Thus, a standard surgical cholecystectomy was carried out and the patient was dismissed on the 3rd postoperative day without any symptoms. However, the patient was admitted again after four days for a new coliky pain attack. An upper endoscopy showed a 23 cm long mobile parasite in the duodenum: it was caught with the polypectomy loap, extracted and identified as A. Lumbricoides. The patient's symptoms disappeared after the endoscopic removal of the worm and she was dismissed the day after the worm's removal. No recurrence of symptoms was noted during a 1-year follow-up. This case showed that A. Lumbricoides infestation of the biliary tree should be considered when biliary and/or pancreatic symptoms recur, especially in patients coming from undeveloped countries. At the same time we showed that endoscopic removal is a safe and effective treatment for this infestation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/8. Marked diffuse dilations of the biliary tree associated with intrahepatic calculi, biliary sludges and a mucinous cyst of the pancreatic head in a 99-year-old woman.A 99-year-old woman was admitted to Shizuoka Shimizu Municipal Hospital because of fever and anasarca. Imaging and laboratory tests showed pneumonia, urinary tract infection, and cardiac failure. The patient died 20 days after admission. An autopsy revealed marked diffuse dilations of the biliary tree ranging from the lower common bile duct to intrahepatic bile ducts. Intrahepatic calcium bilirubinate stones and biliary sludges were recognized within the dilated bile ducts. A unilocular cyst (2 cm in diameter) was present in the pancreatic head adjacent to the lower common bile duct, and it appeared to compress the common bile duct. Histologically, the walls of the dilated biliary tree showed proliferation of peribiliary glands, fibrosis, and infiltration of lymphocytes and neutrophils (cholangitis). The lumens of the dilated biliary ducts contained neutral and acidic mucins, fibrinous materials, bacteria, neutrophils, and aspergillus fungi, in addition to the calculi and sludges. The background liver showed atrophy (400 g). The pancreatic unilocular cyst was composed of mucous columnar cells with a few infoldings, and the pancreas also showed foci of mucinous duct hyperplasia and ectasia; the pathological diagnosis of the cyst was cystic dilations of a pancreatic duct branch (mucinous ductal ectasia or mucinous cyst). Other lesions included aspiration pneumonia, emaciation, atrophy of systemic organs, gastric leiomyoma, serous cystadenoma of the right ovary, and arteriosclerotic nephrosclerosis. The present case suggests that a mucinous cyst of the pancreas may compress the biliary tree and lead to marked diffuse dilations of the biliary tree. Alternatively, the dilations of the bile ducts may be associated with aging or may be of congenital origin. The dilated bile ducts may, in turn, give rise to bacterial and fungal cholangitis and formation of biliary sludges and intrahepatic calcium bilirubinate stones.- - - - - - - - - - ranking = 8keywords = tree (Clic here for more details about this article) |
4/8. CT findings in biliary and pancreatic ascariasis.In a child with biliary and pancreatic ascariasis CT demonstrated liver abscesses and a pancreatic pseudocyst, in addition to air in the biliary tree and main pancreatic duct.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/8. pancreas abscess: a fatal complication of endoscopic cholangiopancreatography (ERCP).Endoscopic retrograde cholangiopancreatography (ERCP) is a popular and extremely useful technique for investigating the pancreatico-biliary tree. While the mortality is low, rare complications i.e., pancreatic abscess, may prove lethal. Surgical backup must be available to obviate recognized complications following ERCP.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/8. Rapid diagnosis of obstructive jaundice due to pancreatic abscess with pancreaticobiliary fistula.A case of pancreatic abscess with pancreaticobiliary fistula manifesting as obstructive jaundice of occult etiology is presented. diagnosis was made preoperatively by skinny needle percutaneous transhepatic cholangiography. In addition, a communication between the biliary tree and the pancreatic abscess cavity was demonstrated in the absence of previous biliary surgery or primary biliary tract disease. We feel this is the procedure of choice for emergency visualization of the biliary tree in a jaundiced patient where a surgically approachable lesion is suspected.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
7/8. Idiopathic retroperitoneal fibrosis producing common bile duct and pancreatic duct obstruction.Idiopathic retroperitoneal fibrosis is a rare finding usually confined to the retroperitoneal space. Symptoms caused by this fibrotic process are usually secondary to compression and constriction of local anatomic structures. The ureters are the most common site of involvement, although the biliary tree, duodenum, and vasculature may also be affected. This case report describes a patient with retroperitoneal fibrosis involving the pancreas and common bile duct, and whose clinical course and investigative results stimulated cancer of the pancreas.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/8. Rapidly progressive sclerosing cholangitis following surgical treatment of pancreatic pseudotumor.Two patients with sclerosing cholangitis presented with a distal stricture of the common bile duct in association with pancreatic pseudotumors. jaundice resolved following surgery to correct biliary obstruction, but diffuse cholangiographic abnormalities and clinical evidence of sclerosing cholangitis became evident 2 and 4 months later. Rapid progression of symptomatic disease necessitated liver transplantation in one patient, but the other had a complete response to methotrexate therapy. The rapid disease progression in these two patients may have been triggered by surgery that resulted in a generalized fibroproliferative response of the biliary tree, already affected with localized sclerosing cholangitis contiguous to a pancreatic pseudotumor. We suggest that localized sclerosing cholangitis associated with pancreatic pseudotumors may be a unique variant that can progress rapidly but respond dramatically to antiinflammatory therapy.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |