Wk 5, Case 2 - Review

EXAM: MRI Cholangiogram MRCP without and with Contrast

INDICATION: 14-year-old male with history of elevated bilirubin as well as pancreatic and liver enzymes.

TECHNIQUE: MR imaging was performed utilizing multiple pulse sequences both before and after the administration of IV contrast, using an MRCP protocol. The pelvis was not included.

FINDINGS:

MRI Abdomen:

The liver size and contour are normal without evidence of fibrosis. There is no hepatic mass or steatosis. There is patent hepatic arterial anatomy, as well as patent portal and hepatic veins. The SMV and splenic veins are patent.

The pancreas is diffusely enlarged with peripancreatic edema. There are segmental areas of decreased enhancement within the pancreatic body and neck, which spare the head and tail. There is subtle delayed capsular enhancement (capsule-rim sign). The common bile duct and pancreatic duct are mildly dilated, with narrowing and caliber change at the pancreatic head.

Stable splenomegaly, measuring up to 15 cm. The adrenal glands are of normal size and morphology. Stable left renal cyst. No hydronephrosis. No evidence of dilated bowel or obstruction. No abnormal areas of contrast enhancement.

The abdominal aorta is normal in caliber, without aneurysmal dilatation. The celiac, splenic, and superior mesenteric arteries are patent. There is no lymphadenopathy.

MRCP:

There is no gallbladder wall thickening or calculi. The common bile duct is mildly dilated and measures up to 4.5 mm. The pancreatic duct is mildly enlarged. Both the pancreatic duct and common bile duct sharply taper at the pancreatic head. There is normal anatomy without pancreas divisum.

IMPRESSIONS:

1. Diffusely enlarged pancreas with peripancreatic edema consistent with pancreatitis. There are findings which raise concern that this may represent autoimmune pancreatitis.
2. Stable dilatation of the common bile duct measuring up to 4.5 mm. Question small linear filling defect within the common bile duct which may represent biliary sludge, less likely stones.