Case 02: MRI Abdomen

Abdominal Pain. MRI Abdomen done.
What is the complete diagnosis?

 


Findings:

1.      Separate opening of the pancreatic duct at the minor papilla – pancreatic duct is seen to course medial to the common bile duct

2.      The lower pole calyces of both kidneys are seen to point medially – IVP equivalent of Horseshoe Kidney on MRCP.

 

Answer:

 

1.      Pancreatic divisum

2.      Horseshoe Kidneys

  

Discussion: Pancreatic Divisum  - the diagnostic finding is demonstrating separate opening of the major pancreatic duct (PD) separate from the CBD. PD is seen to course medial and superior to the CBD opening.

 

Typical finding of horseshoe kidneys on IVP is demonstrating abnormal orientation of the lower pole calyces. These calyces are medially oriented due to lower pole fusion.

 

References:

  

1.      Manfreddi R, Costamagna G et al.  Pancreas Divisum and “Santorinicele”: Diagnosis with Dynamic MR Cholangiopancreatography with Secretin Stimulation.  November 2000 Radiology, 217, 403-408

2.      Leyendecker J R, Barnes C E, Zagoria R J. MR Urography : Technique and Clinical applications. January 2008 RadioGraphics, 28, 23-46

 Contribution: Dr Paresh Desai, Apollo Victor Hospital, Goa