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Figure 11b. IPMT with diffuse duct disease. (a) Postsecretin MR image shows severe dilatation of the main duct in the pancreatic body and tail. The appearance of the duct resembles that in chronic pancreatitis, but dilatation is diffuse, and there is no stricture. Cystic dilatation of the main duct is visible in the head of the pancreas (white arrow). Small low-signal-intensity filling defects in the duct (arrowheads) are likely to be mucous concretions. The ventral duct (black arrow) appears normal. (b) ERCP image shows an extrusion of mucus from a bulging major papilla. There is marked dilatation of the proximal main pancreatic duct (arrowhead). The ventral duct (black arrow) appears normal. The cystic dilatation of the main duct in the pancreatic head is not as well depicted as at MR cholangiopancreatography, but a mucin-related filling defect (white arrow) that was not visible on the MR images is shown. Thin mucin is indistinguishable from pancreatic juices at MR imaging.
