Biliary-tract diagnosis by magnetic resonance imaging
=====================================================

* James H. Bilbey
* Nis Schmidt

A 54-year-old man had a 1-year history of variable epigastric pain accompanied by recent mild jaundice. Initial ultrasonography at a community hospital suggested a mass, which was possibly malignant, in the head of the pancreas. Abdominal computed tomography (Figs. 1 and 2) and repeat ultrasonography (Fig. 3) revealed a tubular structure (white arrows on Figs. 1, 2 and 3) in the expected region of the common duct, extending into the right lobe of the liver and containing fluid and debris that was thought to represent a markedly dilated extrahepatic biliary system. The wall of this structure was thickened (Fig. 3, arrow). In addition, a fluid collection, which was thought to represent a pancreatic pseudocyst, was present in the lesser sac (Fig. 2, black arrow). Endoscopic retrograde cholangiopancreatography failed to demonstrate the common bile duct. Magnetic resonance imaging (Fig. 4, GB = gallbladder, DUO = duodenum) without contrast resolved the question by demonstrating a displaced duct of normal calibre (Fig. 4, black arrows). The tubular collection identified on ultrasonography and computed tomography actually represented a second pancreatic pseudocyst, which concealed the common duct on the other studies.

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/39/4/268/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/39/4/268/F1)

FIG. 1 

![FIG. 2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/39/4/268/F2.medium.gif)

[FIG. 2](http://canjsurg.ca/content/39/4/268/F2)

FIG. 2 

![FIG. 3](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/39/4/268/F3.medium.gif)

[FIG. 3](http://canjsurg.ca/content/39/4/268/F3)

FIG. 3 

![FIG. 4](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/39/4/268/F4.medium.gif)

[FIG. 4](http://canjsurg.ca/content/39/4/268/F4)

FIG. 4 

## Footnotes

*   Section Managers: David P. Girvan, MD, FRCSC and Nis Schmidt, MD, FRCSC

*   Submissions to “Surgical Images” should be sent to Dr. David P. Girvan, Victoria Hospital Corporation, PO Box 5375, Station B, London ON N6A 5A5 or to Dr. Nis Schmidt, Department of Surgery, St. Paul’s Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6, with a copy of the submitting letter to Dr. Jonathan L. Meakins, Rm. S10.34, Royal Victoria Hospital, 687 Pine Ave. W, Montreal QC H3A 1A1.