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1、JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013AtlasofRadiologicalModalitiesintheEvaluationofAmpullaryMassesJohnB.Moore,MSc,HMSIIIGillianLieberman,MDJohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Agenda•PatientPresentation•Normalanatomyofthehepato-pa
2、ncreatico-biliarysystem•Differentialdiagnosisforaperiampullarymass•Menuoftests•RadiologicalevaluationoftheampullaofVater•Categorizingthelesionwithimaging•Discussionofampullarycarcinoma•Correlatingfindingswithprognosis2JohnB.Moore,MSc,MS3GillianLieber
3、man,MDMarch2013Patient1:HPI•58yoMwhopresentedwithsymptomaticobstructivejaundice.Developedpruritusanddarkurineof3weeksdurationbeforepresentation.Mildweightlossoverpast3months.Noabdominalpain,nausea,vomiting,alcoholuse.–PMHsignificantonlyforglaucoma–ta
4、kestimolol–FatherpassedawayfromunknownGImalignancy•Labsweresignificantforfollowing:–ALT:192IU/L–AST:133IU/L–Totalbilirubin:1.9mg/dl–Lipase:1498IU/L–CA19-9:36(normal<34U/ml)3JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Patient1:InitialCT+contrastCBD
5、PancreaticductPancreasSplenicarteryCeliacarterySMVIVCAorta4C+axialCTabdomen&pelvisBIDMC,PACSJohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Patient1:InitialCT+contrastThecommonbileductandthepancreaticductaredilated.Thisfindingisknownasthe“doubleductsi
6、gn”C+axialCTabdomen&pelvisBIDMC,PACS5JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Patient1:InitialCT+contrastC+coronalCTabdomen&pelvisBIDMC,PACSC+coronalCTabdomen&pelvisBIDMC,PACSDilatedcommonbileductandDistendedgallbladderinabsencepancreaticducton
7、coronalimagingofclearobstructinglesionsorstones6JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Patient1:InitialCT+contrastC+coronalCTabdomen&BIDMC,PACSC+coronalCTabdomen&BIDMC,PACSpelvispelvisNoovertmassseenDuodenumwithpancreaticductandCBD7converging
8、inperiampullaryregion.JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013Anatomyoftheperiampullaryregion8JohnB.Moore,MSc,MS3GillianLieberman,MDMarch2013AnatomyoftheampullaFromMartin&Moser,Ampullarycarcinoma,UpToDate9JohnB.Moore,MSc,MS3GillianLieberman,MD
