0:01

So here we see dilated duct in this patient

0:03

with some side branches, and as we follow

0:06

this duct, it becomes more prominent in the

0:08

pancreatic body and the pancreatic head.

0:11

And in this particular location, if we

0:12

measure this duct, it is one centimeter.

0:16

So that falls in the category that suspicion

0:18

of cancer in this case is very, very high.

0:20

One centimeter or more pancreatic

0:21

duct is always very worrisome.

0:24

And then what we see here, if we follow

0:26

this duct further in the pancreatic

0:28

head, it is even more prominent, though

0:31

it drains normally in the major papilla.

0:34

But in addition to that, what we see, there are

0:37

few more cystic lesions in the pancreatic head.

0:40

Those are multilocular, which have citation,

0:44

and those are situated anterior to this duct.

0:49

So here, overall, the picture is not very rosy.

0:54

As we go to the corona and pay attention

0:57

to these ducts, again, we have some

0:59

more lesions in the pancreatic tail.

1:00

Those are looking multilocular and multi-lobulated.

1:04

But as we follow these ducts forward

1:06

in the pancreatic head and the body

1:08

The duct even here is even more prominent,

1:12

so obviously more than one centimeter here.

1:14

And as we reach to the pancreatic head here

1:17

or the periampullary region, we see the

1:19

CBD which is also prominent and dilated.

1:22

And again, the gallbladder here is missing.

1:25

So this dilated duct, CBD can be just because of

1:28

missing gallbladder, but what about this duct?

1:31

This is obviously abnormal.

1:33

And then we are seeing cystic

1:35

lesion in the pancreatic head.

1:36

So seeing multiloculated lesion in the

1:38

pancreatic head with possible Dilated CBD

1:41

and this one centimeter or more CBD, uh,

1:44

pancreatic duct is very, very worrisome.

1:46

And that is going to be a case of

1:48

main duct IPMN, let's see how it

1:50

looks on the post-contrast images.

1:53

Do we see any enhancement within the duct?

1:55

Possibly not, but the caliber

1:58

itself is highly worrisome.

2:01

And those lesions which we have seen

2:02

anteriorly are also showing some

2:05

enhancing thick septations inside.

2:08

And if we measure that particular

2:10

lesion, that is almost 2.7 centimeters.

2:13

53 00:02:14,820 --> 00:02:17,330 So, that falls in the category where we, we

2:17

are almost in the range of 3 cm or closer,

2:20

and we have thick internal enhancing septations.

2:23

So, both of these lesions are suspicious,

2:26

and they should be referred to surgery now.

2:29

So, here we can see on post-contrast images,

2:32

the lesion which is situated anteriorly along

2:34

with the pancreatic head is multiloculated

2:36

and demonstrates thick enhancing septation.

2:39

So, this is most likely a side branch IPMN,

2:43

which is situated along with

2:44

the main branch, branch IPMN.

2:46

So, this will be called a mixed type

2:48

of IPMN together, main and side branch.

2:51

So, in addition to that, we have

2:52

some incidental findings here.

2:53

For example, in the apicycstic region,

2:55

we are seeing a fat-containing and

2:57

ball-containing hernia, and there are

2:59

some incidental cysts in the liver here.