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Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

Hwang JY, Yoon HK, Kim KM - Pediatr Gastroenterol Hepatol Nutr (2015)

Bottom Line: Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children.Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology.This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

ABSTRACT
Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children. Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology. Magnetic resonance cholangiopancreatography (MRCP) is a good imaging modality for evaluating pancreatitis and determining etiology without exposure to radiation. This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

No MeSH data available.


Related in: MedlinePlus

A 3-year-old female diagnosed with acute pancreatitis caused by a type I choledochal cyst and associated with anomalous pancreaticobiliary ductal union and choledocholithiasis. (A) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing fusiform dilatation of the extrahepatic bile duct (type I choledochal cyst, arrow), long common channel (curved arrow), and a stone in the common channel (arrowhead). Note the diffuse dilatation of the pancreatic duct (open arrow). (B) Axial T1-weighted image showing a stone within the common channel (arrow).
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Figure 8: A 3-year-old female diagnosed with acute pancreatitis caused by a type I choledochal cyst and associated with anomalous pancreaticobiliary ductal union and choledocholithiasis. (A) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing fusiform dilatation of the extrahepatic bile duct (type I choledochal cyst, arrow), long common channel (curved arrow), and a stone in the common channel (arrowhead). Note the diffuse dilatation of the pancreatic duct (open arrow). (B) Axial T1-weighted image showing a stone within the common channel (arrow).

Mentions: Choledochal cyst (CDC) is a congenital anomaly that manifests as a dilated bile duct. Combination anomalous pancreaticobiliary ductal union (APBDU) and ductal stones can lead to bile reflux into the pancreatic duct which, in turn, predisposes CDC patients to the development of pancreatitis [2122]. MRCP is a valuable tool for preoperative evaluation because it can objectively determine the size, extent, and type of CDC, APBDU, and cholelithiasis, in addition to presence of pancreatitis (Fig. 8 and 9) [723]. The coexistence of CDC and PD is rarely reported (Fig. 10) [24]. On MRCP, CDC appears as a fluid-filled cystic dilation of the bile duct, which is best seen on T2-weighted imaging. CDC is categorized by the Todani classification system as follows [25]: type I (80-90%), cyst confined to the extrahepatic duct (Fig. 8 and 9); type II (3%), diverticulum of the extrahepatic duct; type III (5%), choledochocele, which is the dilatation of the intramural CBD that protrudes into the duodenum (Fig. 11); type IV (10%), multiple cystic dilatations in both the intra- and extrahepatic ducts (Fig. 10); type V, Caroli disease, manifests as multicystic dilatation of the intrahepatic bile duct and may be associated with renal cystic diseases.


Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

Hwang JY, Yoon HK, Kim KM - Pediatr Gastroenterol Hepatol Nutr (2015)

A 3-year-old female diagnosed with acute pancreatitis caused by a type I choledochal cyst and associated with anomalous pancreaticobiliary ductal union and choledocholithiasis. (A) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing fusiform dilatation of the extrahepatic bile duct (type I choledochal cyst, arrow), long common channel (curved arrow), and a stone in the common channel (arrowhead). Note the diffuse dilatation of the pancreatic duct (open arrow). (B) Axial T1-weighted image showing a stone within the common channel (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493250&req=5

Figure 8: A 3-year-old female diagnosed with acute pancreatitis caused by a type I choledochal cyst and associated with anomalous pancreaticobiliary ductal union and choledocholithiasis. (A) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography image showing fusiform dilatation of the extrahepatic bile duct (type I choledochal cyst, arrow), long common channel (curved arrow), and a stone in the common channel (arrowhead). Note the diffuse dilatation of the pancreatic duct (open arrow). (B) Axial T1-weighted image showing a stone within the common channel (arrow).
Mentions: Choledochal cyst (CDC) is a congenital anomaly that manifests as a dilated bile duct. Combination anomalous pancreaticobiliary ductal union (APBDU) and ductal stones can lead to bile reflux into the pancreatic duct which, in turn, predisposes CDC patients to the development of pancreatitis [2122]. MRCP is a valuable tool for preoperative evaluation because it can objectively determine the size, extent, and type of CDC, APBDU, and cholelithiasis, in addition to presence of pancreatitis (Fig. 8 and 9) [723]. The coexistence of CDC and PD is rarely reported (Fig. 10) [24]. On MRCP, CDC appears as a fluid-filled cystic dilation of the bile duct, which is best seen on T2-weighted imaging. CDC is categorized by the Todani classification system as follows [25]: type I (80-90%), cyst confined to the extrahepatic duct (Fig. 8 and 9); type II (3%), diverticulum of the extrahepatic duct; type III (5%), choledochocele, which is the dilatation of the intramural CBD that protrudes into the duodenum (Fig. 11); type IV (10%), multiple cystic dilatations in both the intra- and extrahepatic ducts (Fig. 10); type V, Caroli disease, manifests as multicystic dilatation of the intrahepatic bile duct and may be associated with renal cystic diseases.

Bottom Line: Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children.Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology.This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

ABSTRACT
Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children. Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology. Magnetic resonance cholangiopancreatography (MRCP) is a good imaging modality for evaluating pancreatitis and determining etiology without exposure to radiation. This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

No MeSH data available.


Related in: MedlinePlus