PMC4897013_01
31-year-old man with autoimmune pancreatitis. Sonography shows (A) common bile duct dilatation without intrahepatic biliary ductal dilatation, and (B) hypoechoic mass in the region of the pancreatic head.
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Based on the physical exam and initial laboratory data, the patient was presumed to have a conjugated hyperbilirubinemia caused by obstruction of the common bile duct; he was therefore sent for ultrasound imaging (Fig. 1).
31-year-old man with autoimmune pancreatitis. CT of the abdomen shows (A) enhancing, heterogeneous pancreatic head mass, and (B) slight intrahepatic duct dilatation and gallbladder distension
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The CT showed a 5 x 3 cm enhancing, heterogeneous mass located in the region of the pancreatic head, with extension into the porta hepatis (Fig. 2).
31-year-old man with autoimmune pancreatitis. ERCP shows (A) normal pancreatic duct, non-beaded narrowing of the distal common bile duct, and (B) proximal dilatation of the common bile duct.
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ERCP (Fig. 3) and stenting of the common bile duct two days following his presentation to the Emergency Department. ERCP showed a normal pancreatic duct, non-beaded narrowing of the distal common bile duct, and dilatation of the common bile duct proximal to the area of stricture.