Magnetic Resonance Cholangiopancreatography (MRCP) for Suspected Bilio-Pancreatic Disease: Should the Endoscopist Take a Second Look?

Cholangiocarcinoma is a primary biliary tract tumor arising from the bile duct epithelium. Classically, these tumors have been categorized according to their anatomic location as intrahepatic and extrahepatic. Hilar cholangiocarcinoma is the most common type of extrahepatic cholangiocarcinoma. It is the most difficult cancer to diagnose and therefore carries a poor prognosis with a 5-year survivalrate of less than 10%. Diagnostic imaging, coupled with a high degree of clinical suspicion, play a critical role in timely diagnosis, staging, and evaluation for surgical resectability. The most common imagingmodalities used for diagnosis and staging of hilar cholangiocarcinoma include ultrasound (US), computed tomography (CT), magnetic resonance imaging/magnetic resonance cholangiopancreatography(MRI/MRCP). This article showed a case presentation and reviewed the imaging appearance of hilar cholangiocarcinoma. Figure 1 Greyscale sonography at the level of hepatic hilum revealed an ill-defined hilar mass (asterisk)resulting in upstream dilatation of right (arrow) and left (arrow head) main intrahepatic duct.

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Non Conspicuity of Biliary Tract by Magnetic Resonance Cholangiopancreatography (MRCP) in Hemobilia post Sphincterotomy

The Bangkok Medical Journal ◽

10.31524/bkkmedj.2013.02.007 ◽

2013 ◽

Vol 05 (01) ◽

pp. 36-38

Author(s):

Chirotchana Suchato ◽

Rergchai Varatorn

Keyword(s):

Magnetic Resonance ◽

Biliary Tract ◽

Magnetic Resonance Cholangiopancreatography

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Pancreatico‑pleural Fistula: Case Series

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_23_17 ◽

2018 ◽

Vol 09 (01) ◽

pp. 026-031 ◽

Cited By ~ 1

Author(s):

Manoj Munirathinam ◽

Pugazhendhi Thangavelu ◽

Ratnakar Kini

Keyword(s):

Magnetic Resonance ◽

Pleural Effusion ◽

Pleural Fluid ◽

Case Series ◽

Magnetic Resonance Cholangiopancreatography ◽

Fluid Analysis ◽

High Index Of Suspicion ◽

Enhanced Computed Tomography ◽

Acute And Chronic Pancreatitis ◽

Pancreatic Pathology

ABSTRACTPancreatico‑pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico‑pleural fistula is usually massive and recurrent. It is predominately left‑sided but right‑sided and bilateral effusion does occur. We report four cases of pancreatico‑pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow‑up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X‑ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast‑enhanced computed tomography abdomen) would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD) reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

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