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Figure 1b. (a) Drawing illustrates papillitis with a distal common bile duct (CBD) stone. Bulging of the papilla is due to inflammation in the ampulla of Vater, which is precipitated by mechanical irritation from choledocholithiasis. (b) Drawing illustrates branch duct type IPMT. Protrusion of the major papilla into the duodenal lumen, as well as mild and symmetric wall thickening, is frequently seen. (c) Drawing illustrates ampullary carcinoma (exposed type). Note the asymmetric and irregularly thickened wall at the distal margin of the pancreaticobiliary junction that obliterates the lumen, along with enlargement of the major duodenal papilla.
