Answer for CoW 28 May 2017
Pancreaticopleural fistula (PPF)
Findings
T2 axial shows enlarged pancreas with irregular contours and nonhomogeneous signal intensity with a pancreatic body pseudocyst and main pancreatic ducct dilatation in the body Coronal T2 demonstrated a part of the proximal portion of the fistula and irregular dilatation track from the main pancreatic duct side branches entering cranially into the esophageal hiatus and branching out into two each entering the pleural cavity.
Discussion
Discussion PPF is seen in 0.4% of pancreatitis . CP related to alcohol abuse (67%) is the most common causative factor in adults while biliary duct obstruction constitutes the major etiological factor in children . Other causes giving rise to PPF include gall stones, abdominal trauma, and pancreatic duct anomalies. Trauma contributes 0.5% of cases . PPF is seen in 4.5% of patients with pancreatic pseudocysts. Conversely, a pseudocyst is found in 43-79% cases of PPF . Development of PPF usually results from posterior leakage of an incompletely formed pseudocyst or rupture of a mature one . The fistulous track traverses across aortic or esophageal hiatus or rarely via transdiaphragmatic route and empties into either (76% times on left or right sided in 19% patients or both pleural spaces (14% of cases) .
Findings
T2 axial shows enlarged pancreas with irregular contours and nonhomogeneous signal intensity with a pancreatic body pseudocyst and main pancreatic ducct dilatation in the body Coronal T2 demonstrated a part of the proximal portion of the fistula and irregular dilatation track from the main pancreatic duct side branches entering cranially into the esophageal hiatus and branching out into two each entering the pleural cavity.
Discussion
Discussion PPF is seen in 0.4% of pancreatitis . CP related to alcohol abuse (67%) is the most common causative factor in adults while biliary duct obstruction constitutes the major etiological factor in children . Other causes giving rise to PPF include gall stones, abdominal trauma, and pancreatic duct anomalies. Trauma contributes 0.5% of cases . PPF is seen in 4.5% of patients with pancreatic pseudocysts. Conversely, a pseudocyst is found in 43-79% cases of PPF . Development of PPF usually results from posterior leakage of an incompletely formed pseudocyst or rupture of a mature one . The fistulous track traverses across aortic or esophageal hiatus or rarely via transdiaphragmatic route and empties into either (76% times on left or right sided in 19% patients or both pleural spaces (14% of cases) .