May 1, 2013

Pancreatic Divisum

An MRCP image shows abnormal drainage of the main pancreatic duct and ventral duct into the minor papilla.

A diagram shows normal pattern of pancreatic duct drainage (label "normal") and pancreatic divisum. Several variants of pancreatic divisum exist but the "classic/typical" one is the MPD draining into the minor papilla while the VD draining into the major papilla along with the CBD. Santorinicele is a fusiform dilatation of the distal MPD before it enters the minor papilla. 

Facts: Pancreatic Divisum 

  • Most common pancreatic anatomic variant, found 7% incidence at autopsy but frequencies differ at ERCP
  • Controversial association with recurrent pancreatitis
  • Results of non-fusion of ventral and dorsal pancreatic anlagen during embryonic time, therefore the ducts (ventral and dorsal ducts are not fused)
  • Dorsal duct drains most of glandular parenchyma through minor papilla
  • Ventral duct drains a portion of pancreatic head (including uncinate process) through major papilla
  • Definitive diagnosis is made with ERCP. MRCP does have high sensitivity and specificity for diagnosis of divisum
  • MDCT with thin section can be used to diagnose pancreatic divisum. Viewing images on PACS is essential for depiction of this condition and the assessment is possible only when the pancreatic duct is visualized.
  • Important criterion = Dorsal duct seen from tail and body through the anterior aspect of the head, draining into minor papilla (located anterior to CBD and major papilla) while the ventral duct seen in posterior region of the pancreatic head and drains into duodenum together with CBD. Dorsal duct is larger than ventral duct and they are not communicated with each other. "Dominant dorsal duct sign"

Soto JA, Lucey BC, Stuhlfaut JW. Pancreas divisum: depiction with multi-detector row CT. Radiology 2005; 235:503-508. 

No comments:

Post a Comment