IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Pancreatic head adenocarcinoma with choledocoduodenal fistula

Case contributed by Ahmed Abdrabou
Diagnosis certain

Presentation

Recurrent abdominal pain and vomiting of 1 month duration

Patient Data

Age: 60 years
Gender: Male

A large irregular pancreatic head mass with extensive necrosis is noted. It is inseparable from the mesenteric vessels, partial thrombosis of the portal vein, dilated pancreatic duct, invades the 2nd part of the duodenum and is associated with massive pneumobilia. There is also contrast filling of the CHD and right posterior hepatic duct suggesting choledoco-duodenal fistula formation. Multiple hypodense hepatic focal lesions as metastatic deposits.

Black arrow refers to the invasion of the 2nd part of the duodenum by the pancreatic mass.

Red and blue arrows refer to the contrast filling the right posterior hepatic duct and CHD respectively.

Case Discussion

Pancreatic duct adenocarcinoma was found on biopsy. The tumor invades the 2nd part of the duodenum and CBD forming a choledocoduodenal fistula that results in massive pneumobilia and the presence of oral contrast within the dilated bile ducts. It was staged as T3N0M1.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.