History of Whipple in 2013 for IPMN with subsequent recurrent acute and chronic pancreatitis. Patient has a history of CREST syndrome, autoimmune thyroiditis and Sjogren's syndrome. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from hepaticojejunostomy. The central biliary tree demonstrates short segment smooth narrowing at the level of the right and left hepatic bile ducts. No focal lesion is evident, however evaluation is limited by lack of intravenous contrast. No significant intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a Whipple procedure. The residual pancreatic body demonstrates normal T1-weighted signal intensity. However, the residual pancreatic tail demonstrates bulbous enlargement, decreased T1-weighted signal intensity and associated restricted diffusion. The main pancreatic duct in the tail demonstrated beaded dilatation measuring up to 4 mm with side branch ectasia. There are small unilocular cystic lesions in the pancreatic tail with the largest measuring 1.2 x 1.0 cm (series 3/20). Following secretin administration there is no significant dilatation in the residual pancreatic duct but there appears to be some excretory function of the parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Bulbous enlargement, restricted diffusion and ectatic dilation of the pancreatic tail suspicious for an inflammatory process. The constellation of findings and the patient's history raises suspicion for auto-immune hepatopancreatitis. An underlying mass lesion cannot be excluded. EUS and tissue sampling is suggested. 2. Abnormal narrowing of the central biliary tree without a focal lesion seen on this limited non-enhanced study; also may be related to auto-immune hepatopancreatitis. 3. Small cystic foci in the pancreatic tail may represent side branch type IPMNs with the largest measuring 1.2 cm without suspicious features, within the limitations of a nonenhanced study.