Reason: 86 yo female with history of pancreas divisum s/p minor sphincterotomy and stent placement as well as major papilla sphincterotomy and balloon dilation in November 2014, now with recurring pancreatic type pain. MRI/MRCP w/ secretin to rule out sphincter re stenosis, also rule out pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The gallbladder is surgically absent. There is mild central intrahepatic ductal dilatation. There is also extrahepatic ductal dilatation up to 16 mm in diameter with dilation nearly up to level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated and measures up to 4 mm in diameter. There appears to be mild stricturing of the main pancreatic duct at the level of the pancreatic head. The major duct courses inferiorly at the level of the common bile duct and then ascends and empties into the minor papilla. The minor duct is nondilated and drains into the ampulla. These findings are consistent with pancreatic divisum. There is a 5 mm cystic focus in the pancreatic body which appears in continuity with the main pancreatic duct (series 4, image 17) and which may reflect a dilated side branch or a side branch IPMN. There is an additional similar lesion in the pancreatic tail also in continuity with the main duct (4, image 16) measuring 5 x 10 mm. There are additional similar smaller lesions within the uncinate process.Post-secretin images demonstrate reduced compliance of the pancreatic duct with satisfactory exocrine function.The pancreatic parenchyma appears atrophic with decreased T1 signal suggesting chronic pancreatitis. No discrete pancreatic masses are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septations, not significantly changed. Additional renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Pancreas divisum and findings consistent with chronic pancreatitis. Diminished pancreatic duct compliance. Satisfactory pancreatic exocrine function.2.Mild stricturing of the main pancreatic duct at the level of the pancreatic head without significant dilation of the main pancreatic duct.3.Several new small cystic lesions along the pancreatic ducts which may reflect dilated side branches or IPMNs. 4.Persistent dilation of the common bile duct up until the level of the ampulla.