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British Journal of Radiology (2008) 81, e13-e16
© 2008 British Institute of Radiology
doi: 10.1259/bjr/77979574
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Spontaneous pancreatic pseudocyst-portal vein fistula presenting with pancreatic ascites: strength of MR cholangiopancreatography

S E Yoon, MD1, Y-H Lee, MD1, K-H Yoon, MD1, C S Choi, MD2, H-C Kim, MD2 and K M Chae, MD3

Departments of 1 Radiology, 2 Internal Medicine and 3 Surgery, Wonkwang University School of Medicine, 344-2 Sinyongdong, Iksan, Jeonbuk 570-711, Korea


Figure 1
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  		Figure 1. (a) Contrast-enhanced CT scan shows massive ascites (asterisks) and a pancreatic duct dilatation (arrowhead) with mild parenchymal atrophy. Note the presence of a pseudocyst with internal debris in the pancreas head (arrows). (b) Contrast-enhanced CT scan shows low-attenuated fluid with no contrast enhancement of the portal vein (arrow), and cavernous transformation around the portal vein (arrowheads). Note an intrahepatic bile duct dilatation (open arrowhead) and massive ascites (asterisks).

 

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  		Figure 2. ERCP shows faint opacification of a pseudocyst(arrows) and the portal vein (arrowheads). However, ERCP did not show any pancreatic juice leak into the peritoneal cavity, which can be responsible for massive pancreatic ascites. b, common bile duct.

 

Figure 3
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  		Figure 3. (a) MRCP clearly demonstrates pancreatic juice leak through the pancreatic pseudocyst-portal vein fistula (arrowheads), liver dome (arrow) and into the peritoneal cavity (asterisks). (b) Intraoperative pseudocystography via a catheter (arrow) shows the pseudocyst-portal vein fistula (arrowheads). Note a large amount of contrast material spilling into the duodenum (asterisk); this accounted for the inability to demonstrate pancreatic leak. b, common bile duct; ps, pancreatic pseudocyst.

 




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