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Intraductal papillary mucinous neoplasms - side branch type

Case contributed by Bruno Di Muzio
Diagnosis almost certain

Presentation

Incidental finding on CT, for further investigation.

Patient Data

Age: 70 years
Gender: Female

There are multiple subcentimeter pancreatic cyst lesions in keeping with small side branch IPMNs without nodularity, enhancement, or other imaging worrisome features. The one located at the tail of the pancreas tail is the largest one, measuring today 12 mm in diameter. The main pancreatic duct is not dilated and the pancreas parenchyma appears otherwise normal.

There is no intra or extra hepatic biliary tree dilatation. The liver parenchyma has a homogeneous signal intensity, without focal lesions. There is diffuse signal drop throughout the liver on T1 opposed phase in keeping with diffuse fatty infiltration. The adrenal glands and spleen are normal.  The imaged portions of the kidneys have unremarkable appearances.  No lymphadenopathy within the superior abdomen.

 

MIP reformat and select T2 HASTE image showing the multiple small pancreatic cysts that do not show evidence of communication with the main pancreatic duct. 

Case Discussion

The imaging features are those of multiple side branch IPMNs without worrisome features. Fatty liver is also demonstrated characterized by drop of signal on IP-OOP

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