Korean J Radiol.  2013 Jun;14(3):412-415. 10.3348/kjr.2013.14.3.412.

Compression of the Main Pancreatic Duct by the Intrapancreatic-Replaced Common Hepatic Artery

• Lee HY
• Ha HI
• Kim MJ
• Lim HK

• KMID: 1705452
• DOI: http://doi.org/10.3348/kjr.2013.14.3.412

Abstract

We describe a unique case of a patient who presented with a linear, transverse, and incidentally-detected main pancreatic duct dilatation that was caused by the intrapancreatic-replaced common hepatic artery, detected on the MDCT, MRCP and endoscopic retrograde cholangiopancreatography. We believe this case to be the first of its kind reported in the literature.

Keyword

Compression; Main pancreatic duct; Intrapancreatic common hepatic artery

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic/complications/diagnosis
Dilatation, Pathologic/diagnosis/etiology
Hepatic Artery/*abnormalities
Humans
Incidental Findings
Magnetic Resonance Imaging
Male
Middle Aged
*Pancreatic Ducts
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Imaging findings of main pancreatic duct compression by intrapancreatic-replaced common hepatic artery in 63-year-old man. A, B. On curved coronal (A) and axial (B) multiplanar reconstruction images obtained on arterial phase (15 seconds after contrast injection on bolus tracking method), common hepatic artery (black arrow) arises from superior mesenteric artery (white arrow) is crossing pancreatic parenchyma and causing compression of main pancreatic duct (small double arrows). Celiac trunk is normally arising from aorta, superiorly (A, *). C, D. Endoscopic retrograde cholangiopancreatography shows tubular filling defect of main pancreatic duct (C, arrow) and dilatation of upstream main pancreatic duct in addition to stasis of contrast medium (D). E. Coronal T2-weighted image (repetition time [TR]/echo time [TE], 1728/80; slice thickness, 3 mm) shows intrapancreatic-replaced common hepatic artery representing as tubular signal void (arrow), which is crossing and compressing main pancreatic duct (arrowheads). F. Coronal maximum-intensity projection of respiratory triggered 3-dimensional turbo spin echo MRCP image (TR/TE, 1868/600) demonstrates clear defect of main pancreatic duct at neck area (arrow) and dilatation of upstream main pancreatic duct.

Reference

1. Furukawa H, Shimada K, Iwata R, Moriyama N. A replaced common hepatic artery running through the pancreatic parenchyma. Surgery. 2000. 127:711–712.

2. Abdullah SS, Mabrut JY, Garbit V, De La Roche E, Olagne E, Rode A, et al. Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat. 2006. 28:468–473.

3. Jah A, Jamieson N, Huguet E, Praseedom R. The implications of the presence of an aberrant right hepatic artery in patients undergoing a pancreaticoduodenectomy. Surg Today. 2009. 39:669–674.

4. Bisognano JD, Young B, Brown JM, Gill EA, Fang FC, Zisman LS. Diverse presentation of aberrant origin of the right subclavian artery: two case reports. Chest. 1997. 112:1693–1697.

5. Alper F, Akgun M, Kantarci M, Eroglu A, Ceyhan E, Onbas O, et al. Demonstration of vascular abnormalities compressing esophagus by MDCT: special focus on dysphagia lusoria. Eur J Radiol. 2006. 59:82–87.

6. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007. 24:149–156.

7. Raman SP, Neyman EG, Horton KM, Eckhauser FE, Fishman EK. Superior mesenteric artery syndrome: spectrum of CT findings with multiplanar reconstructions and 3-D imaging. Abdom Imaging. 2012. 37:1079–1088.

8. Watanabe H, Iwase H, Sugitani M, Watanabe T. Compression of the common bile duct by the posterosuperior pancreaticoduodenal artery: case report. Abdom Imaging. 2005. 30:214–217.

9. Cole PE, Saluja S. Pollack HM, McClennan BL, Dyer RB, editors. Vascular Abnormalities of the Lower Urinary Tract. Clinical Urography. 2000. 2nd ed. Boston: W.B Saunders;2563–2580.

10. Stern JM, Park S, Anderson JK, Landman J, Pearle M, Cadeddu JA. Functional assessment of crossing vessels as etiology of ureteropelvic junction obstruction. Urology. 2007. 69:1022–1024.