Navigating the Pancreatic Duct: Up-to-Date Radiologic Expedition through Intraluminal Pathologic Entities

Several congenital, traumatic, infectious, inflammatory, and neoplastic processes, as well as iatrogenic interventions, can alter intraluminal contents of the pancreatic duct, leading to adverse outcomes. Variant ductal anatomy may result in clinically significant complications such as duodenal obstruction, acute and chronic pancreatitis, and increased risk of developing gallbladder or biliary malignancies. The presence of calculi, blood, pus, and other unintended iatrogenic material in the pancreatic duct can be associated with a range of complications. Neoplastic involvement of the pancreatic duct by entities other than ductal adenocarcinoma is uncommon but may occur secondary to tumor extension into the duct or de novo development. CT and MRI or MR cholangiopancreatography are the most commonly used imaging modalities for evaluating the pancreatic duct and associated pathologic processes. Endoscopic US and endoscopic retrograde cholangiopancreatography are more invasive imaging options that also provide the option of simultaneous intervention, if needed. The authors include discussion of the imaging appearances of various congenital anomalies and pathologic processes of the pancreatic duct and complications of ductal disruption and abnormal intraluminal contents. The section on neoplasia provides an up-to-date review of imaging manifestations of recently described neoplastic entities that develop within the pancreatic duct. Awareness of these abnormalities and their imaging correlates may help radiologists improve patient care.