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Click 50 year-old female with pancreatic duct-portal vein fistula.
Axial contrast enhanced CT image in arterial phase demonstrates clear lung bases and a normal size heart. The liver is enlarged with edge blunting and heterogeneous parenchyma. The intrahepatic portal veins are dilated and fluid attenuation. The main portal vein is dilated measuring 16 mm and is water attenuation measuring 4.42 Hounsfield units. There are collateral vessels within the hepatic hilum and there are small peri-gastric varices.
The pancreas attenuates normally but 3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. The pancreatic duct is not dilated. A larger, 2.6 cm pseudocyst is present within the pancreatic tail.
The spleen is not enlarged. There are small abdominal ascites. There are aortic calcifications but no aneurysm is present in the aorta or the mesenteric arteries. The gallbladder and bile ducts are not dilated and the kidneys and adrenals are normal. The bowel is non-obstructed and mild cecal and ascending colonic thickening is related to portal colopathy.
(Protocol 64 slice scanner, Arterial-phase 2.0mm axial images. 260 mAs, 120 kV, 100 ml iopamidol (Isoview 370, Bracco Diagnostics Milan, Italy))

Click 50 year-old female with pancreatic duct-portal vein fistula.
Axial contrast enhanced CT image in 5 minute delayed phase demonstrates clear lung bases and a normal size heart. The liver is enlarged with edge blunting and heterogeneous parenchyma. The intrahepatic portal veins are dilated and fluid attenuation. The main portal vein is dilated measuring 16 mm and is water attenuation measuring 4.42 Hounsfield units. There are collateral vessels within the hepatic hilum and there are small peri-gastric varices.
The pancreas attenuates normally but 3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. The pancreatic duct is not dilated. A larger, 2.6 cm pseudocyst is present within the pancreatic tail.
The spleen is not enlarged. There are small abdominal ascites. There are aortic calcifications but no aneurysm is present in the aorta or the mesenteric arteries. The gallbladder and bile ducts are not dilated and the kidneys and adrenals are normal. The bowel is non-obstructed and mild cecal and ascending colonic thickening is related to portal colopathy.
(Protocol: 64 slice scanner, 5 minute delayed phase 3.0mm axial image. 64 slice scanner, 260 mAs, 120 kV, 100 ml iopamidol (Isoview 370, Bracco Diagnostics Milan, Italy), 900cc gastroview, Mallinckrodt Inc, Saint Louis, MO))


Click 50 year-old female with pancreatic duct-portal vein fistula.
Axial T2 HASTE FAT SAT MRI images without contrast demonstrate clear lung bases and a normal size heart. The liver is enlarged and blunted. The portal vein is dilated measuring 1.5 cm with intraluminal fluid signal intensity and absence of flow void. There are collateral flow voids in the hepatic hilum and there are small peri-gastric varices.
The pancreas demonstrates 3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. The pancreatic duct is not dilated. A larger, 2.6 cm pseudocyst is present within the pancreatic tail. A tiny fluid signal intensity tract extending from the pancreatic duct is in close proximity to the main portal vein.
The spleen is not enlarged. There are small abdominal ascites. Aortic and IVC flow voids are normal. The gallbladder is normal and bile ducts are not dilated. The kidneys and adrenals are normal. The bowel is non-obstructed.
(Protocol: MRI, 1.5T, TR 2000, TE 90 without contrast)


Click 50 year-old female with pancreatic duct-portal vein fistula.
Axial T2 HASTE FAT SAT THIN MRI images without contrast demonstrate clear lung bases and a normal size heart. The liver is enlarged and blunted. The portal vein is dilated measuring 1.5 cm with intraluminal fluid signal intensity and absence of flow void. There are collateral flow voids in the hepatic hilum and there are small peri-gastric varices.
The pancreas demonstrates 3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. The pancreatic duct is not dilated. A larger, 2.6 cm pseudocyst is present within the pancreatic tail.
The spleen is not enlarged. There are small abdominal ascites. Aortic and IVC flow voids are normal. The gallbladder is normal and bile ducts are not dilated. The kidneys and adrenals are normal. The bowel is non-obstructed.
(Protocol: MRI, 1.5T, TR 2000, TE 241 without contrast)


Click 50 year-old female with pancreatic duct-portal vein fistula.
CORONAL T2 HASTE FAT SAT MRI images without contrast demonstrate an enlarged liver with fluid signal intensity, dilated portal vein measuring 1.5 cm in diameter.
3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. The pancreatic duct is not dilated. A larger, 2.6 cm pseudocyst is present within the pancreatic tail.
The spleen is not enlarged. There are small abdominal ascites. Aortic and IVC flow voids are normal. The gallbladder is normal and bile ducts are not dilated. The kidneys and adrenals are normal. The bowel is non-obstructed. The heart base and lung bases are normal.
(Protocol: MRI, 1.5T, TR 2000, TE 92 without contrast)


Click 50 year-old female with pancreatic duct-portal vein fistula.
3D CORONAL SPACE MRCP images without contrast demonstrate an enlarged liver with fluid signal intensity, dilated portal vein measuring 1.5 cm in diameter. The intra-hepatic bile ducts are not dilated. The extra-hepatic common bile duct is not dilated and a stricture is present in the pancreatic segment. The main pancreatic duct is not dilated in the body and tail. The duct is not well seen after it passes the fluid signal intensity portal vein.
3 pseudocysts are present within the pancreatic head, the largest of which measures 1.4 cm. A larger, 2.6 cm pseudocyst is present within the pancreatic tail.
There are small abdominal ascites. The gallbladder is unremarkable.
(Protocol: 1.5T, TR 4448, TE 710 without contrast)


Click 50 year-old female with pancreatic duct-portal vein fistula.
A/P projection percutaneous transhepatic portogram shows needle access within the proximal left intrahepatic branch of the portal vein and contrast opacification of the portal vein demonstrating complete stasis of flow. No contrast reflux into the superior mesenteric or splenic veins is demonstrated. A 7 French, 7cm biliary stent is present in the extra-hepatic bile duct. A/P projection magnification view shows a contrast opacified portal vein with extension of contrast into the main pancreatic duct. The 7 French, 7cm biliary stent is in the extrahepatic common bile duct.


Click 50 year-old female with pancreatic duct-portal vein fistula.
A/P projection ERCP shows contrast opacification of the common bile duct and main pancreatic duct. The gallbladder is not opacified. There is no intrahepatic or extrahepatic biliary duct dilatation. A stricture is within the extra-hepatic common bile duct at the pancreatic head. The main pancreatic duct is not dilated but contrast fills a pseudocyst near the pancreatic head-neck junction. The portal vein is not opacified. A 7F, 7cm biliary stent is placed across the common bile duct stricture.
A/P ERP magnified images shows an irregular main pancreatic duct in the pancreatic head with tortuous side branch ducts consistent with chronic pancreatitis. The main pancreatic duct in the body is normal caliber and pseudocyst is at the pancreatic head-neck junction.