PMC10159321_01
An 82-year-old man with Lemmel syndrome who presented with intermittent abdominal pain and jaundice. (a and b) Axial and coronal contrast-enhanced computed tomography (CT) scan of the abdomen shows dilation of the intrahepatic duct (arrow in a) and common bile duct (CBD) (arrow in b) without demonstrable cholelithiasis. (c) CT image with coronal reconstruction shows a large air-filled periampullary duodenal diverticulum (asterisk) showing narrow communication with the duodenal lumen (open arrow) was located adjacent to the distal CBD (arrow in c).
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F2
Therefore, the patient was referred for a contrast-enhanced abdominal computed tomography (CT) scan, which also revealed diffuse dilatation of the intrahepatic bile ducts and CBD with abrupt tapering of the distal CBD [Figure 2a and b]. In addition, a large air-filled PAD showing narrow communication with the duodenal lumen was located at the distal CBD [Figure 2c].
An 82-year-old man with Lemmel syndrome who presented with intermittent abdominal pain and jaundice. (a and b) Coronal T2-weighted magnetic resonance imaging of the abdomen shows an 8.3-cm periampullary diverticulum (asterisk) mechanically compressing the biliary duct with distal common bile duct (CBD) (arrow in a) and pancreatic ductal dilatation (open arrow in b). Occluded cholangiogram showed dilated CBD without filling defect (c).
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F3
T2-weighted MRI of the abdomen was demonstrated in [Figure 3a and b]. Cholangiography showed dilatation of the CBD with no filling defect [Figure 3c].