0:00

So this is another case here, and we have

0:03

the similar problem, a dilated duct and then

0:06

duct caliber is significantly higher in this

0:09

location, and we measure it and it is almost

0:16

1.2 centimeters.

0:17

So we have a duct approximately

0:19

which is dilated up to 1.

0:20

2 centimeters, which is highly worrisome, but what

0:23

we see inside this duct, there is some intensity.

0:28

So inside the duct, we can

0:29

see some of the intensity.

0:30

Which is T2 weighted

0:32

isointense to high point intense.

0:34

So this can be a mucus ball or it

0:36

can be a growth, which we can confirm

0:39

after the contrast has been given.

0:41

And as we follow this duct,

0:43

which becomes just normal, as soon as we

0:45

reach, reach to the pancreatic head.

0:47

And it opens normally in the,

0:49

in the major papilla here.

0:51

So here in this location,

0:52

pancreatic duct just looks normal.

0:54

And as soon as we reach to, we reach to

0:56

the pancreatic head and the neck region.

0:58

We see this kind of dilatation,

1:01

which has some internal focus of hypointensity.

1:05

And then, as we move backwards, we see some

1:08

of the dilated side branches or actasia.

1:10

And let's see how it looks on

1:11

the coronal T2 weighted images.

1:14

Here we can see the same kind of pattern.

1:16

And this is the hypointense legion within

1:19

the duct we have seen on the axial.

1:22

And this is the main pancreatic duct,

1:23

which is opening in the major papilla, along with

1:26

the CVD, which looks just normal in caliber.

1:29

And there are few side

1:30

branch IPMNs on the backside.

1:33

Which we can better see in the tail region

1:36

and the head region, but they are very small

1:38

and they look classically bunch of grapes.

1:41

So this is the classical appearance

1:42

of side branch IPMNs wherever they are

1:44

because they are usually in, in, they are

1:46

multiple, and they are in bunches together.

1:50

So let's see how it looks on MRCP.

1:51

Rectal dilatation, side branch actasia, some of

1:57

the side branch IPMN and on post-contrast,

2:02

this is the arterial phase, and what we see here,

2:06

that area of hypointensity, a focus of hypointensity

2:10

within the duct actually shows enhancement.

2:13

And this particular focus is big enough

2:17

to be called as more than 5, 5 millimeters.

2:20

So almost like

2:21

1.3 centimeters here.

2:23

So this particular focus inside is

2:26

not a very good sign because this

2:27

is going to be cancer most likely.

2:30

So this is a cancer developed on the background of

2:32

IPMN, which is best seen on post-contrast images.

2:35

Thank you.

2:36

Venus phase, we can see it further.

2:39

It's even bigger than what we thought initially.

2:41

There is another focus in the neighborhood,

2:43

which is better seen on these images.

2:46

So this was a case of IPMN developing malignant

2:49

transformation and coexisting side branch IPMN.