PMC4326036_01
MRCP images arrow showing sausage-like pancreas in delayed phase.
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fig1
The pancreatic parenchyma is diffusely hypoenhancing, with focal hypoenhancement within pancreatic head, distal body, and tail (Figure 1).
Endoscopic ultrasound images arrows showing (clockwise) (a) CBD stricture, (b) dilated CHD, (c) reactive lymph node, and (d) homogenous pancreatic body.
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fig2
In view of her clinical presentation with worsening jaundice and MRCP findings, an endoscopic ultrasound (EUS) was done that revealed a diffusely hypoechoic and rounded pancreatic parenchyma with distal common bile duct (CBD) stricture and dilated proximal CBD and common hepatic duct (CHD) (Figure 2).
ERCP arrows showing CBD and MPD strictures pre stent insertion (a) and (b); post stent insertion (c) and (d) (clockwise).
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fig3
Endoscopic retrograde cholangiopancreatography (ERCP) showed tight mid to distal CBD stricture that needed dilatation, sphincterotomy, and placement of stent that significantly improved her clinical symptoms and bilirubin level (Figure 3).