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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.


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A 1-year-old female with acute necrotizing pancreatitis caused by a type I choledochal cyst and anomalous pancreaticobiliary ductal union. (A) Coronal T2-weighted image showing slightly increased signal intensity in the pancreas (arrow), a large amount of ascites, and a choledochal cyst (asterisk). Note the acute necrotic collections (arrowheads) and stone in the long common channel (curved arrow). (B) Maximum intensity projection 3-dimensional magnetic resonance cholangiopancreatography image showing union between the pancreatic duct and bile duct (arrow), which makes a long, common channel that measures approximately 10 mm. Note the choledochal cyst (asterisk) and the large acute necrotic collections (arrowheads), as well as the mild dilatation of the pancreatic duct (curved arrow).
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Figure 9: A 1-year-old female with acute necrotizing pancreatitis caused by a type I choledochal cyst and anomalous pancreaticobiliary ductal union. (A) Coronal T2-weighted image showing slightly increased signal intensity in the pancreas (arrow), a large amount of ascites, and a choledochal cyst (asterisk). Note the acute necrotic collections (arrowheads) and stone in the long common channel (curved arrow). (B) Maximum intensity projection 3-dimensional magnetic resonance cholangiopancreatography image showing union between the pancreatic duct and bile duct (arrow), which makes a long, common channel that measures approximately 10 mm. Note the choledochal cyst (asterisk) and the large acute necrotic collections (arrowheads), as well as the mild dilatation of the pancreatic duct (curved 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 1-year-old female with acute necrotizing pancreatitis caused by a type I choledochal cyst and anomalous pancreaticobiliary ductal union. (A) Coronal T2-weighted image showing slightly increased signal intensity in the pancreas (arrow), a large amount of ascites, and a choledochal cyst (asterisk). Note the acute necrotic collections (arrowheads) and stone in the long common channel (curved arrow). (B) Maximum intensity projection 3-dimensional magnetic resonance cholangiopancreatography image showing union between the pancreatic duct and bile duct (arrow), which makes a long, common channel that measures approximately 10 mm. Note the choledochal cyst (asterisk) and the large acute necrotic collections (arrowheads), as well as the mild dilatation of the pancreatic duct (curved arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4493250&req=5

Figure 9: A 1-year-old female with acute necrotizing pancreatitis caused by a type I choledochal cyst and anomalous pancreaticobiliary ductal union. (A) Coronal T2-weighted image showing slightly increased signal intensity in the pancreas (arrow), a large amount of ascites, and a choledochal cyst (asterisk). Note the acute necrotic collections (arrowheads) and stone in the long common channel (curved arrow). (B) Maximum intensity projection 3-dimensional magnetic resonance cholangiopancreatography image showing union between the pancreatic duct and bile duct (arrow), which makes a long, common channel that measures approximately 10 mm. Note the choledochal cyst (asterisk) and the large acute necrotic collections (arrowheads), as well as the mild dilatation of the pancreatic duct (curved 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