PMC9292327_01
Contrast-enhanced abdominal CT. (A) Contrast-enhanced CT reveals exudation around the pancreas and slight dilatation of the pancreatic duct, (B) a thickened peritoneum and cloudy mesentery, and (C) avid enhancement with accompanying ureterectasia (white arrow).
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Contrast-enhanced CT revealed exudation around the pancreas, slight dilatation of the pancreatic duct (Figure 1A), a thickened peritoneum, and cloudy mesentery (Figure 1B), which are encountered often in abdominal inflammatory reactions such as acute pancreatitis or lupus. An unexpected finding, however, was that the left ureter was thickened and showed avid enhancement (Figure 1C) accompanied by ureterectasia (Figure 1A).
Magnetic resonance cholangiopancreatography and abdominal magnetic resonance imaging. (A) Magnetic resonance cholangiopancreatography shows highly suspected diffuse hypertrophy of the extrahepatic biliary tract, inferior biliary tract stenosis, and multiple strictures of the intrahepatic biliary tract. (B) Abdominal magnetic resonance imaging suggests that the intrahepatic bile duct wall is significantly thickened, and diffusion was significantly restricted on diffusion-weighted imaging. (C) Diffusion-weighted imaging reveals that the entire pancreas demonstrated diffuse high signal. (D) A thickened peritoneum is evident.
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Instead of proportional dilatation in continuation with the extrahepatic bile duct, the intrahepatic duct showed multiple strictures (Figure 2A). The narrowed segments of the biliary tracts were thickened symmetrically, and diffusion was significantly restricted on diffusion-weighted imaging (Figure 2B). Segmental stenosis of the main pancreatic duct was noted in the pancreatic head, with slight dilation of the upstream pancreatic duct, which did not exceed 3 mm (Figure 2A). The entire pancreas demonstrated diffuse high signal on diffusion-weighted imaging (Figure 2C). A thickened mesentery and peritoneal fascia were also observed (Figure 2D).
18FFDG positron emission tomography-computed tomography. (A, D, E)
18FFDG PET-CT reveals left renal perirenal fascial thickening with abnormal metabolic elevation (black arrow and white arrow), and (B, C) inflammatory change in the pancreas.
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Percutaneous transhepatic cholangiography and drainage and biliary stent implantation was performed for obstructive cholangitis considering her continuously elevated bilirubin level. 18FFDG positron emission tomography-computed tomography (PET-CT) (Figure 3) detected left renal perirenal fascial thickening with abnormal metabolic elevation and inflammatory changes in the bile duct and pancreas, without evidence of abdominal tumor-metastasis.
Contrast-enhanced abdominal CT after treatment. (A) Contrast-enhanced CT reveals less inflammatory reactions of the pancreas. (B) Thickness of peritoneum maintained without further thickening and left ureterectasia partly relieved (white arrow).
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The patient was followed up for 6 months, and an enhanced abdominal CT revealed that there was less inflammatory reaction of the pancreas (Figure 4A), and the thickness of the renal fascia and peritoneum maintained without further thickening (Figure 4B). More importantly, her ureterectasia on the left side was partly relieved (Figure 4B), and a double-J stent was not needed.