PMC6514518_01
Baseline MR imaging. a Axial gadolinium-enhanced T1 image showing signs of acute pancreatitis with an enlargement of the pancreatic tail and a mild stranding of the peripancreatic spaces. b MR cholangiopancreatography showing a stricture of the left hepatic duct with upstream dilatation of the bile ducts of the left hepatic lobe.
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F1
Antinuclear antibodies were negative and a PET CT confirmed the absence of other organ damage (see Fig. 1, 2, 3, 4).
a Overview of one representative SharkCore biopsy showing a slight nonstoriform interlobular fibrosis of the pancreatic tissue, exhibiting a heterogeneous inflammatory infiltrate with predominant neutrophilic accumulation within the interlobular spaces (inset). b Detailed view of the inset in a showing neutrophilic infiltrates (arrowhead) with inconspicuous periacinar lymphoplasmacytic and histiocytic accumulation. c Detailed view of the immunostaining results showing no IgG4-positive plasma cells. This combination of histological and immunostaining findings is highly suggestive for type 2 autoimmune pancreatitis. H&E staining. Original magnification, a x10, b x60. IgG4 stain (Cell marque , 1: 50). Original magnification, c x40.
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F2
Antinuclear antibodies were negative and a PET CT confirmed the absence of other organ damage (see Fig. 1, 2, 3, 4).
a The second percutaneous transhepatic cholangiography shows a main stricture (arrow) of the right hepatic duct with upstream dilatation of the bile ducts of the right liver. b Three internal external drainage tube are placed in the right anterior and posterior segments of the right liver and in the left hepatic lobe.
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F3
Antinuclear antibodies were negative and a PET CT confirmed the absence of other organ damage (see Fig. 1, 2, 3, 4).
Control MR imaging. a Axial gadolinium-enhanced T1 image showing diffuse hypotrophy of the pancreas, but without signs of acute pancreatitis. b MR cholangiopancreatography showing a mild dilatation of the intrahepatic bile ducts, but without residual strictures of the main bile ducts.
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F4
Antinuclear antibodies were negative and a PET CT confirmed the absence of other organ damage (see Fig. 1, 2, 3, 4).