PMC6243317_01
Multidetector CT, portal phase, coronal reconstruction shows hypoattenuating cystic lesion encircling the wall of the second part of the duodenum (arrowhead), with also circumferential wall thickening (arrows).
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fig1
Next, a multidetector CT (MDCT) scan was performed and revealed cystic lesions completely encircling the second portion of the duodenum (Figure 1).
Mutidetector CT, portal phase, axial image shows thickening of the wall of the second portion of the duodenum, within which, on the pancreatic side, a cystic lesion can be appreciated (thin arrow); in addition, soft tissue almost isodense to the pancreas is seen between the pancreatic head and the duodenal wall (thick arrows).
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fig2
In addition, there was a solid component in the so-called pancreaticoduodenal groove, strictly contiguous to the pancreatic head, with heterogeneous enhancing pattern and areas isodense to the pancreas (Figure 2).
Multidetector CT, portal phase, axial image shows inflammatory changes involving the paraduodenal area with fluid (arrow) and fat thickening (arrowhead).
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fig3
Although these findings were suggestive of pancreatitis (Figure 3), the pancreatic head as well as the pancreatic duct appeared normal.
Coronal T2 weighted MRI shows intramural fluid-signal intensity lesions within the descending portion of the thickened duodenal wall (arrowhead) and sheet-like tissue adjacent to it (thin arrows), consistent with cystic dystrophy.
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MRI (Figures 4-5) revealed the same MDCT scan findings, and an MR cholangiopancreatography confirmed normal gallbladder and no dilatation of the CBD or the pancreatic duct.
Axial T1 weighted MRI, portal phase shows pattern of enhancement of the sheet-like tissue in the pancreaticoduodenal groove, which is similar to the pancreas (thick arrow); within the duodenal wall there is a fluid-containing hypointense lesion (thin arrow).
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fig5
MRI (Figures 4-5) revealed the same MDCT scan findings, and an MR cholangiopancreatography confirmed normal gallbladder and no dilatation of the CBD or the pancreatic duct.