PMC3982637_01
Ultrasonography image showing the pseudocyst (star) with debris in dependant portion, communicating with the portal vein (arrow)
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F1
The USG (Fig. 1) showed the portal vein as anechoic but with no color flow within and also showed communication between the cyst and portal vein.
(A) Axial contrast-enhanced computed tomography (CECT) section showing a pseudocyst (arrow) at the neck of pancreas. (B) Axial CECT image at a cranial level showing hypodensity within the dilated right portal vein (arrowhead) with multiple periportal collaterals (black arrow) and area of necrosis in adjacent segment of liver (white arrow)
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F2
The CECT showed the pseudocyst (Fig. 2 A) in the pancreatic neck and completely thrombosed portal vein and its branches (Fig. 2 B) which was misinterpreted as dilated CBD on EUS.
(A) T2-weighted fat suppressed axial imaging showing the portal vein and the pseudocyst communication with plaque-like material (arrow) along the posterior wall of portal vein which is hypointense on T2-imaging. The main pancreatic duct (short arrow) is prominent and likely communicates with the pseudocyst (star). (B) Corresponding T1W fat suppressed axial section showing the T2 hypointense lesion along the posterior wall to be hyperintense on T1W image (arrow) suggesting residual part of lysed thrombus
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F3
T2-weighted imaging and hypointense on T1-weighted imaging. There was some plaque-like material along the wall of the main portal vein and its branches which showed hyperintense signal on T1-weighted imaging and hypointense on T2-weighted imaging (Fig. 3, 4).
(A) T2W fat suppressed axial image showing the right portal vein (arrow) to be hyperintense, containing fluid-like material. Area of necrosis (arrowhead) seen in right lobe of liver adjacent to the right portal vein. (B) Corresponding post contrast T1W fat suppressed axial section showing no contrast opacification of the portal vein (white arrow) with multiple small periportal collaterals (black arrow) and no enhancement in the area of liver necrosis
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F4
T2-weighted imaging and hypointense on T1-weighted imaging. There was some plaque-like material along the wall of the main portal vein and its branches which showed hyperintense signal on T1-weighted imaging and hypointense on T2-weighted imaging (Fig. 3, 4). On post contrast images there was no opacification of the portal vein (Fig. 4B).