Imaging Findings in Agenesis of the Dorsal Pancreas. Report of Three Cases
Abstract
Context Agenesis of the dorsal pancreas is rare. The dorsal pancreatic agenesis is described in two forms, the partial and the complete form. Patients with this anomaly may be asymptomatic or may present with diabetes mellitus, epigastric pain, acute or chronic pancreatitis. Case report We report the computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) findings in three cases with dorsal pancreatic agenesis, one with partial and the other two with complete form. Speckled calcification at pancreatic head was observed in one patient. Lateral contour lobulation of pancreatic head which is seen in one third of normal population is believed to be due to variation in fusion between ventral and dorsal pancreas. In contrast, we observed lateral contour lobulation of pancreatic head in a case of complete agenesis of the dorsal pancreas where structures derived from dorsal pancreas are undeveloped. The ventral and dorsal pancreatic duct lengths were measured on MRCP images and we observed that in partial agenesis, the duct of Wirsung was shorter in length, compared to the duct of Santorini. The duct of Wirsung was relatively longer in cases of complete agenesis of the dorsal pancreas. Conclusion The CT, MRI and MRCP findings in dorsal pancreatic agenesis and the relationship between the length of ventral duct with the type of dorsal pancreatic agenesis will provide a new insight into this particular anomaly.
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References
Voldsgaard P, Kryger-Baggesen N, Lisse I. Agenesis of pancreas. Acta Paediatr 1994; 83:791-3. [PMID 7949819]
Schnedl WJ, Reisinger EC, Schreiber F, Pieber TR, Lipp RW, Krejs GJ. Complete and partial agenesis of the dorsal pancreas within one family. Gastrointest Endosc 1995; 42(5):485-7. [PMID 8566643]
Karcaaltincaba M. CT differentiation of distal pancreas fat replacement and distal pancreas agenesis. Surg Radiol Anat 2006; 28:637-641. [PMID 17033736]
Uygur-Bayramicli O, Dabak R, Kilicoglu G, Dolapcioglu C, Oztas D. Dorsal pancreatic agenesis. JOP 2007; 8: 450-452. [PMID 17625298]
Shah KK, De Ridder PH, Schwab RE et al. CT diagnosis dorsal pancreas agenesis. J Comput Assist Tomogr 1987; 11(1): 170-1. [PMID 3805410]
Lechner GW, Read RC. Agenesis of the dorsal pancreas in an adult diabetic presenting with duodenal ileus. Ann Surg 1966; 163 (2) :311-14. [PMID 5906622]
Gold RP. Agenesis and pseudoagenesis of the dorsal pancreas. Abdominal Imaging 1993; 18(2):141-144. [PMID 8439753]
Pasaoglu L, Vural M, Hatipoglu H G, Tereklioglu G, Koparala S. Agenesis of the dorsal pancreas. World J Gastroenterol 2008 May 14; 14(18):2915-2916. [PMID 18473421]
Balakrishnan V, Narayanan V A, Siyad I, Laxmi R , Prem N. Agenesis of the dorsal pancreas with chronic calcific pancreatitis . Case report, Review of the literature and genetic basis. JOP 2006 Nov 10 ; 7(6):651-659 . [PMID 17095847]
Maier M, Wiesner W, Mengiardi B. Annular pancreas and agenesis of the dorsal pancreas in a patient with polysplenia syndrome. AJR2007;188(2):150-153. [PMID 17242221]
Ross BA, Jeffrey RB Jr, Mindelzun RE. Normal variations in the lateral contour of the head and neck of the pancreas mimicking neoplasm: evaluation with dual-phase helical CT. Am J Roentgenol 1996;166:799-801. [PMID 8610553]
Sempere L, Aparicio JR, Martinez J, Casellas JA, Dee Madaria E, Perez-Mateo M. Role of endoscopic ultrasound in diagnosis of agenesis of the dorsal pancreas. JOP. J Pancreas (Online) 2006; 7:411-6. [PMID 16832139]
Klein WA, Friedman AC, Caroline DF, Boden GH, et al. Agenesis of dorsal pancreas in patient with weight loss and diabetes mellitus. Dig Dis Sci; 1994:1708-13. [PMID 8050322]
Nishimori I, Okazaki K, Mortita M, Miyao M, Sakamoto Y et al. Congenital hypoplasia of the dorsal pancreas with special reference to duodenal papillary dysfunction. Am J Gastroenterol 1990;85:1029-33. [PMID 2197855]
DU J, Xu GQ, Xu P, Jin EY, Liu Q, Li YM. Congenital short pancreas. Chin Med J 2007; 120(3):259-262. [PMID 17355836]
Rakesh K, Choung OW, Reddy DN. Agenesis of the dorsal pancreas (ADP) and pancreatitis - is there an association? Indian J Gastroenterol 2006; 25:35-6. [PMID 16567893]
Schnedl WJ, Piswanger-soelkner C, wallner SJ, Krause R, Lipp RW. Agenesis of the dorsal pancreas. World J Gastroenterol 2009; 15(3):376-377. [PMID 19140241]
Rahier J, Guiot Y, Goebbels RM, Sempoux C, Henquin JC. Pancreatic beta-cell mass in European subjects with type 2 diabetes. Diabetes Obes Metab. 2008 Nov;10 Suppl 4:32-42. [PMID 18834431]
Haumaitre C, Barbacci E, Jenny M, Ott MO, Gradwohl G, Cereghini S. Lack of TCF2/vHNF1 in mice leads to pancreas agenesis. Proc Natl Acad Sci U S A 2005; 102:1490-5. [PMID 15668393]
Macari M, Giovanniello G, Blair L, Krinsky G. Diagnosis of agenesis of the dorsal pancreas with MR pancreatography. Am J Roentgenol 1998; 170 (1):144-6. [PMID 9423620]
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