17-year-old male patient:
* Cholestatic jaundice, otherwise healthy
* Ultrasound showed extensive biliary tree dilatation
What should be done next?
What should be done next?
*MRCP
*Non-contrast MR of the abdomen with MRCP was performed
MRCP ImagesMRCP Image
T2 images, axial and coronalT2 Axial ImageT2 Coronal Image
DWI (left) with ADC map (right)DWI with ADC mapDescribe the findings
Describe the findings
*Marked biliary tree dilatation, common bile duct almost 2 cm wide with abrupt caliber change at the level of the pancreatic head
*No gallstones seen in biliary ducts or the distended gallbladder
*Diffuse pancreatic enlargement with marked restricted diffusion, no peripancreatic fat stranding, free fluid or collections
*Main pancreatic duct narrowing, barely visible
Differential diagnosis includes…
Differential diagnosis includes…
*Pancreatic cancer (especially diffuse infiltrative)
*Pancreatic lymphoma
*Autoimmune pancreatitis
Autoimmune pancreatitis is:
– Rare type of chronic pancreatitis
– Associated with IgG4-related sclerosing disease and autoimmune diseases
– Bulky appearance of the pancreas on imaging (“sausage shaped”), main pancreatic duct narrowing and absence of peripancreatic inflammatory changes seen in the acute pancreatitis
– Stenosis of the common bile duct is typical
What is the best course in treatment?
What is the best course in treatment?
Corticosteroids
Follow-up MRCP three weeks later showed improvement after corticosteroid therapy
Cholecystectomy was also performed
