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Answer B
Objective: Recognize the clinical presentation and imaging features of main duct intraductal papillary mucinous neoplasm (IPMN)
Critique: The patient’s imaging is consistent with main duct IPMN and the mild pancreatitis is likely a consequence of mucin plugging and obstruction. Main duct IPMN is associated with a higher incidence of malignancy, compared with branch duct IPMN and surgical resection is recommended if the patient is a surgical candidate.
While further sampling with endoscopic ultrasound or endoscopic retrograde cholangiopancreatography may be helpful, these tests have a low sensitivity for identifying dysplasia and are unlikely to change management. Surveillance with MRI would be appropriate if the patient does not wish to undergo surgery at this time.
Answer B
Objective: Recognize the clinical presentation and imaging features of main duct intraductal papillary mucinous neoplasm (IPMN)
Critique: The patient’s imaging is consistent with main duct IPMN and the mild pancreatitis is likely a consequence of mucin plugging and obstruction. Main duct IPMN is associated with a higher incidence of malignancy, compared with branch duct IPMN and surgical resection is recommended if the patient is a surgical candidate.
While further sampling with endoscopic ultrasound or endoscopic retrograde cholangiopancreatography may be helpful, these tests have a low sensitivity for identifying dysplasia and are unlikely to change management. Surveillance with MRI would be appropriate if the patient does not wish to undergo surgery at this time.
Answer B
Objective: Recognize the clinical presentation and imaging features of main duct intraductal papillary mucinous neoplasm (IPMN)
Critique: The patient’s imaging is consistent with main duct IPMN and the mild pancreatitis is likely a consequence of mucin plugging and obstruction. Main duct IPMN is associated with a higher incidence of malignancy, compared with branch duct IPMN and surgical resection is recommended if the patient is a surgical candidate.
While further sampling with endoscopic ultrasound or endoscopic retrograde cholangiopancreatography may be helpful, these tests have a low sensitivity for identifying dysplasia and are unlikely to change management. Surveillance with MRI would be appropriate if the patient does not wish to undergo surgery at this time.
A 72-year-old man is admitted to the hospital with mild acute pancreatitis. He reports vague abdominal pain for the past 3 months. He is otherwise healthy and has well-controlled hypertension. He is active and exercises three times a week. CT scan reveals a markedly dilated main pancreatic duct with no stricture as shown below in representative axial and coronal images (Figures 1, 2).