J Korean Soc Magn Reson Med.  2014 Jun;18(2):171-175. 10.13104/jksmrm.2014.18.2.171.

Non-invasive MR Demonstration of the Fistula between Pancreatic Pseudocyst and Portal Vein: A Case Report

• Kim SM
• Lee YH
• Kang UR

• KMID: 2099894
• DOI: http://doi.org/10.13104/jksmrm.2014.18.2.171

Abstract

Pancreatic pseudocyst rupture into the portal vein is a very rare complication and only three reported cases were confirmed using MRI. We report the case of a 50-year-old man with fistula formation between the pseudocyst and the portal vein, confirmed noninvasively by MRI. T2-weighted MR images and magnetic resonance cholangiopancreatography showed fluid signal intensity within the portal, superior mesenteric, and splenic veins, and a direct communication between the pseudocyst and the portal vein.

Keyword

Pancreatic pseudocyst; Portal vein thrombosis; Pancreatitis; Magnetic resonance imaging; MRCP

MeSH Terms

Cholangiopancreatography, Magnetic Resonance
Fistula*
Humans
Magnetic Resonance Imaging
Middle Aged
Pancreatic Pseudocyst*
Pancreatitis
Portal Vein*
Rupture
Splenic Vein
Venous Thrombosis

Figure

• 

  Fig. 1 Contrast enhanced CT. a. A 4 cm pseudocyst (asterisk) in the region of neck of the pancreas. b. Fluid density is seen within the thrombosed superior mesenteric (arrow) and splenic veins (arrowheads) without contrast enhancement. c. Fluid density is also seen within the main portal vein (arrow) and the right portal vein (arrowheads) is completely thrombosed. Cavernous transformation around the thrombosed portal vein.

• 

  Fig. 2 a-c. Single-shot FSE T2-weighted images show a communication of the pseudocyst (asterisk) with the splenoportal confluence (arrow). Fluid signal intensity is seen within the main portal (curved arrow) and left portal (open arrow) veins. Right portal vein thrombosis (arrowheads) shows intermediate to low signal intensity. d. Coronal MIP MRCP image clearly demonstrates a direct communication of the pseudocyst (asterisk) with the splenoportal confluence. Fluid signal intensity is seen within the main portal (arrow), left portal (open arrow), and splenic (arrowheads) veins. Bile duct (curved arrow). e. T1-weighted SPGR image. Right portal vein thrombosis (arrowheads) shows intermediate signal intensity. Low signal intensity is seen within the main portal vein (curved arrow). f. Fat-saturated contrast-enhanced axial T1-weighted SPGR image. No contrast enhancement is seen in the right (arrowheads) and main portal vein (curved arrow).

Reference

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