case_images: PMC6243317_01
case_images: Multidetector CT, portal phase, coronal reconstruction shows hypoattenuating cystic lesion encircling the wall of the second part of the duodenum (arrowhead), with also circumferential wall thickening (arrows).
case_images: bjrcr.20160058.g001.jpg
case_images: PMC6243317_01_bjrcr.20160058.g001.jpg
case_images: fig1
case_images: Next, a multidetector CT (MDCT) scan was performed and revealed cystic lesions completely encircling the second portion of the duodenum (Figure 1).
case_images: Mutidetector CT, portal phase, axial image shows thickening of the wall of the second portion of the duodenum, within which, on the pancreatic side, a cystic lesion can be appreciated (thin arrow); in addition, soft tissue almost isodense to the pancreas is seen between the pancreatic head and the duodenal wall (thick arrows).
case_images: bjrcr.20160058.g002.jpg
case_images: PMC6243317_01_bjrcr.20160058.g002.jpg
case_images: fig2
case_images: In addition, there was a solid component in the so-called pancreaticoduodenal groove, strictly contiguous to the pancreatic head, with heterogeneous enhancing pattern and areas isodense to the pancreas (Figure 2).
case_images: Multidetector CT, portal phase, axial image shows inflammatory changes involving the paraduodenal area with fluid (arrow) and fat thickening (arrowhead).
case_images: bjrcr.20160058.g003.jpg
case_images: PMC6243317_01_bjrcr.20160058.g003.jpg
case_images: fig3
case_images: Although these findings were suggestive of pancreatitis (Figure 3), the pancreatic head as well as the pancreatic duct appeared normal.
case_images: Coronal T2 weighted MRI shows intramural fluid-signal intensity lesions within the descending portion of the thickened duodenal wall (arrowhead) and sheet-like tissue adjacent to it (thin arrows), consistent with cystic dystrophy.
case_images: bjrcr.20160058.g004.jpg
case_images: PMC6243317_01_bjrcr.20160058.g004.jpg
case_images: fig4
case_images: MRI (Figures 4-5) revealed the same MDCT scan findings, and an MR cholangiopancreatography confirmed normal gallbladder and no dilatation of the CBD or the pancreatic duct.
case_images: Axial T1 weighted MRI, portal phase shows pattern of enhancement of the sheet-like tissue in the pancreaticoduodenal groove, which is similar to the pancreas (thick arrow); within the duodenal wall there is a fluid-containing hypointense lesion (thin arrow).
case_images: bjrcr.20160058.g005.jpg
case_images: PMC6243317_01_bjrcr.20160058.g005.jpg
case_images: fig5
case_images: MRI (Figures 4-5) revealed the same MDCT scan findings, and an MR cholangiopancreatography confirmed normal gallbladder and no dilatation of the CBD or the pancreatic duct.