Giarraputo Leonardo, Savastano Sergio, Napetti Sara
Ospedale San Bortolo, Vicenza, Italy.
Ospedale San Bortolo di Vicenza, Italy.
Pancreatology. 2020 Apr;20(3):569-570. doi: 10.1016/j.pan.2020.01.018. Epub 2020 Feb 17.
Embryology of the human pancreas is very complex and any alteration in its development may lead to congenital biliopancreatic malformations and anomalies not thoroughly studied in literature. We here report a case of trifurcation of the Wirsung duct, avery unusual variant of the main pancreatic duct.
An 80- year-old woman underwent a magnetic resonance imaging (MRI) of the abdomen and a magnetic resonance cholangiopancreatography (MRCP) to characterize a hypoechoic lesion of the pancreas detected with ultrasonography.
MRI and MRCP showed a 24-mm multicystic lesion communicating with a prominent main pancreatic duct, consistent with an intraductal papillary mucinous neoplasm, as well as an ansa pancreatica. Moreover a bifidity of the distal pancreatic duct and a further accessory duct of the body of the pancreas draining into the main pancreatic duct were identified. The pancreatic tail presented normal size and morphology on axial imaging. This anomaly, not reported yet in the literature, can be categorized as a number of a duplication anomaly, in which the main pancreatic duct is trifurcated along its length.
Congenital anomalies of the pancreas and pancreatic duct are rare but not uncommonly detected on diagnostic imaging. MRI and MRCP are the non-invasive imaging modalities of choice for diagnosing congenital anomalies of the pancreas and the pancreatic duct.
人类胰腺的胚胎学非常复杂，其发育过程中的任何改变都可能导致先天性胆胰畸形，而这些畸形在文献中尚未得到充分研究。我们在此报告一例主胰管的非常见变异——维尔松管（Wirsung duct）三分叉的病例。
一名80岁女性接受了腹部磁共振成像（MRI）和磁共振胰胆管造影（MRCP）检查，以明确超声检查发现的胰腺低回声病变的特征。
MRI和MRCP显示一个24毫米的多囊性病变与一条明显的主胰管相通，符合导管内乳头状黏液性肿瘤，以及一个胰袢。此外，还发现胰腺远端导管双叉分支以及胰腺体部另一条副胰管汇入主胰管。胰腺尾部在轴位成像上大小和形态正常。这种异常在文献中尚未见报道，可归类为重复畸形的一种，即主胰管在其走行过程中出现三分叉。
胰腺和胰管的先天性异常较为罕见，但在诊断性影像学检查中并不少见。MRI和MRCP是诊断胰腺和胰管先天性异常的首选非侵入性影像学检查方法。
