case_images: PMC4326036_01
case_images: MRCP images arrow showing sausage-like pancreas in delayed phase.
case_images: CRIGM2015-924532.001.jpg
case_images: PMC4326036_01_CRIGM2015-924532.001.jpg
case_images: fig1
case_images: The pancreatic parenchyma is diffusely hypoenhancing, with focal hypoenhancement within pancreatic head, distal body, and tail (Figure 1).
case_images: Endoscopic ultrasound images arrows showing (clockwise) (a) CBD stricture, (b) dilated CHD, (c) reactive lymph node, and (d) homogenous pancreatic body.
case_images: CRIGM2015-924532.002.jpg
case_images: PMC4326036_01_CRIGM2015-924532.002.jpg
case_images: fig2
case_images: In view of her clinical presentation with worsening jaundice and MRCP findings, an endoscopic ultrasound (EUS) was done that revealed a diffusely hypoechoic and rounded pancreatic parenchyma with distal common bile duct (CBD) stricture and dilated proximal CBD and common hepatic duct (CHD) (Figure 2).
case_images: ERCP arrows showing CBD and MPD strictures pre stent insertion (a) and (b); post stent insertion (c) and (d) (clockwise).
case_images: CRIGM2015-924532.003.jpg
case_images: PMC4326036_01_CRIGM2015-924532.003.jpg
case_images: fig3
case_images: Endoscopic retrograde cholangiopancreatography (ERCP) showed tight mid to distal CBD stricture that needed dilatation, sphincterotomy, and placement of stent that significantly improved her clinical symptoms and bilirubin level (Figure 3).