A santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla. Most cases reported previously were associated with pancreas divisum and a santorinicele without pancreas divisum is known to be rare. We recently experienced a typical case of a santorinicele without pancreas divisum in a 67-yr-old woman with abdominal pain and hematochezia, subsequently proven to be the result of an ischemic colitis. The santorinicele was diagnosed incidentally with multi-detector row computed tomography using a minimum intensity projection technique, which clearly showed a cystic dilatation of the terminal portion of the dorsal pancreatic duct and a communication between the ventral and dorsal pancreatic ducts. This finding was also confirmed by a magnetic resonance cholangiopancreatography.
Tomography, X-Ray Computed/methods ; Pancreatic Ducts/pathology/*radiography ; Pancreatic Cyst/pathology/radiography ; Pancreas/pathology/radiography ; Humans ; Female ; Dilatation, Pathologic ; Aged

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.
Ampulla of Vater/anatomy & histology/radiography ; Choledochal Cyst/pathology/radiography ; Diverticulum/radiography ; Duodenal Diseases/pathology/*radiography ; Duodenum/*anatomy & histology/radiography ; Humans ; *Magnetic Resonance Imaging ; Pancreas/abnormalities/anatomy & histology/radiography ; Pancreatic Diseases/radiography

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.
Adenocarcinoma, Mucinous/pathology/radiography ; Humans ; Lung/pathology/*radiography ; Lung Neoplasms/pathology/radiography ; Male ; Middle Aged ; Pancreas/pathology ; Pancreatic Neoplasms/*complications/pathology ; Papilloma, Intraductal/pathology/radiography ; Pulmonary Embolism/pathology/*radiography ; Pulmonary Infarction/pathology/*radiography ; Thrombotic Microangiopathies/diagnosis/*radiography ; Tomography, X-Ray Computed

A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy.
Aged ; Capsule Endoscopy ; Diagnosis, Differential ; Female ; Gastrointestinal Hemorrhage/*diagnosis/surgery ; Humans ; Intestine, Small/radiography ; Jejunum/pathology ; Pancreas/pathology

Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.
Cholangiopancreatography, Magnetic Resonance/*methods ; Humans ; Multidetector Computed Tomography/*methods ; Pancreas/abnormalities ; Pancreatic Diseases/congenital/pathology/radiography ; Pancreatic Ducts/*abnormalities

OBJECTIVE: To investigate the image quality (IQ) and apparent diffusion coefficient (ADC) of reduced field-of-view (FOV) di-ffusion-weighted imaging (DWI) of pancreas in comparison with full FOV DWI. MATERIALS AND METHODS: In this retrospective study, 2 readers independently performed qualitative analysis of full FOV DWI (FOV, 38 × 38 cm; b-value, 0 and 500 s/mm²) and reduced FOV DWI (FOV, 28 × 8.5 cm; b-value, 0 and 400 s/mm²). Both procedures were conducted with a two-dimensional spatially selective radiofrequency excitation pulse, in 102 patients with benign or malignant pancreatic diseases (mean size, 27.5 ± 14.4 mm). The study parameters included 1) anatomic structure visualization, 2) lesion conspicuity, 3) artifacts, 4) IQ score, and 5) subjective clinical utility for confirming or excluding initially considered differential diagnosis on conventional imaging. Another reader performed quantitative ADC measurements of focal pancreatic lesions and parenchyma. Wilcoxon signed-rank test was used to compare qualitative scores and ADCs between DWI sequences. Mann Whitney U-test was used to compare ADCs between the lesions and parenchyma. RESULTS: On qualitative analysis, reduced FOV DWI showed better anatomic structure visualization (2.76 ± 0.79 at b = 0 s/mm² and 2.81 ± 0.64 at b = 400 s/mm²), lesion conspicuity (3.11 ± 0.99 at b = 0 s/mm² and 3.15 ± 0.79 at b = 400 s/mm²), IQ score (8.51 ± 2.05 at b = 0 s/mm² and 8.79 ± 1.60 at b = 400 s/mm²), and higher clinical utility (3.41 ± 0.64), as compared to full FOV DWI (anatomic structure, 2.18 ± 0.59 at b = 0 s/mm² and 2.56 ± 0.47 at b = 500 s/mm²; lesion conspicuity, 2.55 ± 1.07 at b = 0 s/mm² and 2.89 ± 0.86 at b = 500 s/mm²; IQ score, 7.13 ± 1.83 at b = 0 s/mm² and 8.17 ± 1.31 at b = 500 s/mm²; clinical utility, 3.14 ± 0.70) (p < 0.05). Artifacts were significantly improved on reduced FOV DWI (2.65 ± 0.68) at b = 0 s/mm² (full FOV DWI, 2.41 ± 0.63) (p < 0.001). On quantitative analysis, there were no significant differences between the 2 DWI sequences in ADCs of various pancreatic lesions and parenchyma (p > 0.05). ADCs of adenocarcinomas (1.061 × 10⁻³ mm²/s ± 0.133 at reduced FOV and 1.079 × 10⁻³ mm²/s ± 0.135 at full FOV) and neuroendocrine tumors (0.983 × 10⁻³ mm²/s ± 0.152 at reduced FOV and 1.004 × 10⁻³ mm²/s ± 0.153 at full FOV) were significantly lower than those of parenchyma (1.191 × 10⁻³ mm²/s ± 0.125 at reduced FOV and 1.218 × 10⁻³ mm²/s ± 0.103 at full FOV) (p < 0.05). CONCLUSION: Reduced FOV DWI of the pancreas provides better overall IQ including better anatomic detail, lesion conspicuity and subjective clinical utility.
Adult ; Aged ; Artifacts ; Diagnosis, Differential ; *Diffusion Magnetic Resonance Imaging ; *Echo-Planar Imaging ; Female ; Humans ; Male ; Middle Aged ; Pancreas/*radiography ; Pancreatic Diseases/pathology/*radiography ; Pancreatic Neoplasms/pathology/radiography ; Retrospective Studies

Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
Adult ; Anastomosis, Surgical/methods ; Diagnostic Imaging/methods ; Drainage/methods ; Female ; Graft Rejection/pathology ; Graft Survival ; Humans ; Iliac Artery/radiography/surgery ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; *Medical Illustration ; Mesenteric Artery, Superior/radiography/surgery ; Middle Aged ; Pancreas/*blood supply/radiography ; Pancreas Transplantation/adverse effects/*methods ; Pancreatitis, Graft/etiology ; Portal Vein/radiography/surgery ; Postoperative Complications/radiography ; Postoperative Hemorrhage/etiology ; Survival Rate

Hydatid disease (HD) is an endemic illness in many countries, and it poses an important public health problem that's influenced by peoples' socioeconomic status and migration that spreads this disease. Although rare, it may occur in any organ or tissue. The most common site is the liver (59-75%), followed in frequency by lung (27%), kidney (3%), bone (1-4%) and brain (1-2%). Other sites such as the heart, spleen, pancreas and muscles are very rarely affected. Unusual sites for this disease can cause diagnostic problems. This pictorial essay illustrates various radiological findings of HD in the liver, spleen, kidney, pancreas, peritoneal cavity, omentum, adrenal, ovary, lung, mediastinum and retroperitoneum. Familiarity with the imaging findings of HD may be helpful in making an accurate diagnosis and preventing potential complications.
Abdominal Cavity/parasitology/radiography ; Adolescent ; Adult ; Child ; Child, Preschool ; Contrast Media/administration & dosage ; Digestive System/pathology/radiography/ultrasonography ; Digestive System Diseases/diagnosis/parasitology ; Echinococcosis/*diagnosis/parasitology/*radiography ; Endocrine Glands/parasitology/radiography ; Female ; Humans ; Kidney/parasitology/pathology ; Liver/parasitology/radiography ; Lung/parasitology/radiography ; Magnetic Resonance Imaging/methods ; Male ; Mediastinum/parasitology/radiography ; Middle Aged ; Pancreas/parasitology/radiography ; Radiographic Image Enhancement/methods ; Spleen/parasitology/radiography ; Tomography, X-Ray Computed/methods

Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features.
Carcinoma, Acinar Cell/*pathology/*radiography/surgery ; Cholangiopancreatography, Magnetic Resonance/methods ; Diagnosis, Differential ; Diarrhea ; Endocrine Gland Neoplasms/*pathology/*radiography/surgery ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Middle Aged ; Pancreas/pathology/radiography/surgery ; Pancreatectomy ; Pancreatic Neoplasms/*pathology/*radiography/surgery ; Splenectomy ; Tomography, X-Ray Computed/methods

Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.
Gastrinoma/metabolism/pathology/ultrasonography ; Gastrins/metabolism ; Humans ; Immunohistochemistry ; Liver/radiography ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/radiography ; Middle Aged ; Multimodal Imaging ; Multiple Endocrine Neoplasia Type 1/complications/*diagnosis/radiography ; Pancreas/radiography/radionuclide imaging ; Pituitary Gland/radiography ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Thyroid Gland/ultrasonography ; Tomography, X-Ray Computed ; Urolithiasis/*diagnosis/etiology ; Zollinger-Ellison Syndrome/complications/*diagnosis