Figure 11d. Branch duct IPMT of the pancreatic neck. (a) Transverse US scan at the level of the upper midabdomen shows the pancreatic parenchyma with no evidence of MPD dilatation. A roughly triangular hypoechoic lesion (cursors) is seen along the left margin of the pancreatic head, close to the mesenteric vessels (*). The common bile duct is slightly dilated (arrow). (b, c) CT scans (presented from cranial [b] to caudal [c]) obtained after intravenous administration of secretin (100 IU) show a communication (arrow) between the cystic lesion (*) and the MPD. The MPD is slightly dilated. c = common bile duct. (d) ERCP image shows passage of contrast material from the MPD to cystically dilated branch ducts in the pancreatic neck. Pancreatoduodenectomy was performed.