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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 accompanied by a type I choledochal cyst, anomalous pancreaticobiliary ductal union, and atypical incomplete pancreas divisum. (A) Endoscopic retrograde cholangiopancretography (ERCP) demonstrating the fusion of the dorsal (short arrow) and ventral pancreatic duct (arrowhead) that drains into the minor papilla (long arrow). Note mild and fusiform dilatation of the common bile duct that is connected to the ventral duct. The filling defect within the common bile duct is bowel gas. Major papillae are not depicted on ERCP. (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography showing the long common channel draining into the major papilla (arrow). Note the stone in the common channel (arrowhead), and which was not seen on ERCP.
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Figure 12: A 3-year-old-female diagnosed with acute pancreatitis accompanied by a type I choledochal cyst, anomalous pancreaticobiliary ductal union, and atypical incomplete pancreas divisum. (A) Endoscopic retrograde cholangiopancretography (ERCP) demonstrating the fusion of the dorsal (short arrow) and ventral pancreatic duct (arrowhead) that drains into the minor papilla (long arrow). Note mild and fusiform dilatation of the common bile duct that is connected to the ventral duct. The filling defect within the common bile duct is bowel gas. Major papillae are not depicted on ERCP. (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography showing the long common channel draining into the major papilla (arrow). Note the stone in the common channel (arrowhead), and which was not seen on ERCP.

Mentions: In patients with APBDU, bile reflux can occur due to a dysfunctional sphincter of Oddi or because the common channel becomes obstructed by a stone, sludge, or protein plugs [26]. The maximum length of the normal common channel in children increases with age, and the maximum length of the common channel is reportedly 3 mm in infants and 5 mm in children between 3-15 years of age [2728]. A common channel >5 mm would be considered abnormal in children [7]. It may be difficult to identify APBDU on MRCP, particularly in young patients. A long common channel is represented as a single, tubular, high-signal intensity on MRCP after joining the CBD and pancreatic duct (Fig. 8, 9, 12). However, it may be difficult to identify APBDU on MRCP, particularly in young patients due to small caliber of the bile duct.


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 accompanied by a type I choledochal cyst, anomalous pancreaticobiliary ductal union, and atypical incomplete pancreas divisum. (A) Endoscopic retrograde cholangiopancretography (ERCP) demonstrating the fusion of the dorsal (short arrow) and ventral pancreatic duct (arrowhead) that drains into the minor papilla (long arrow). Note mild and fusiform dilatation of the common bile duct that is connected to the ventral duct. The filling defect within the common bile duct is bowel gas. Major papillae are not depicted on ERCP. (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography showing the long common channel draining into the major papilla (arrow). Note the stone in the common channel (arrowhead), and which was not seen on ERCP.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 12: A 3-year-old-female diagnosed with acute pancreatitis accompanied by a type I choledochal cyst, anomalous pancreaticobiliary ductal union, and atypical incomplete pancreas divisum. (A) Endoscopic retrograde cholangiopancretography (ERCP) demonstrating the fusion of the dorsal (short arrow) and ventral pancreatic duct (arrowhead) that drains into the minor papilla (long arrow). Note mild and fusiform dilatation of the common bile duct that is connected to the ventral duct. The filling defect within the common bile duct is bowel gas. Major papillae are not depicted on ERCP. (B) Single-shot radial acquisition with relaxation enhancement magnetic resonance cholangiopancreatography showing the long common channel draining into the major papilla (arrow). Note the stone in the common channel (arrowhead), and which was not seen on ERCP.
Mentions: In patients with APBDU, bile reflux can occur due to a dysfunctional sphincter of Oddi or because the common channel becomes obstructed by a stone, sludge, or protein plugs [26]. The maximum length of the normal common channel in children increases with age, and the maximum length of the common channel is reportedly 3 mm in infants and 5 mm in children between 3-15 years of age [2728]. A common channel >5 mm would be considered abnormal in children [7]. It may be difficult to identify APBDU on MRCP, particularly in young patients. A long common channel is represented as a single, tubular, high-signal intensity on MRCP after joining the CBD and pancreatic duct (Fig. 8, 9, 12). However, it may be difficult to identify APBDU on MRCP, particularly in young patients due to small caliber of the bile duct.

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