Preliminary Diagnosis: Pancreatic Pseudocyst
I. What imaging technique is first-line for this diagnosis?
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CT scan of the abdomen and pelvis with oral and intravenous contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic pseudocyst.
Advantages
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Highly sensitive and specific in detecting a primary abnormality, such as a pseudocyst, and detecting and characterizing any secondary complications
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May help guide treatment and therapy
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Offers exquisite detail of the surrounding anatomical structures
Disadvantages
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Exposes patients to ionizing radiation.
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients
IV. What alternative imaging techniques are available?
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MR of the abdomen and pelvis with IV contrast
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Ultrasound
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Endoscopic retrograde cholangiopancreatography (ERCP)
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Magnetic resonance cholangiopancreatography (MRCP)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic pseudocyst.
MR of the abdomen and pelvis with IV contrast
Advantages
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Does not expose patients to ionizing radiation
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Offers exquisite detail of the surrounding soft tissues and helps characterize the extent of soft tissue invasion and extension
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More sensitive and specific in characterizing the internal pseudocyst fluid content than CT
Disadvantages
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Offers poor evaluation of the surrounding vascular and soft tissues
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Less adept in guiding treatment
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Expensive
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Time consuming
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Requires significant patient cooperation to minimize artifact
Ultrasound
Advantages
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Highly portable imaging modality
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May help guide percutaneous treatment and therapy
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Offers exquisite visualization of any surrounding vascularity
Disadvantages
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Less adept in detailing the surrounding anatomical structures
ERCP
Advantages
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Offers the opportunity for diagnostic evaluation and therapeutic treatment simultaneously
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May provide better anatomical detail of the pancreatic process and surrounding soft tissues than other imaging modalities
Disadvantages
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Invasive procedure associated with greater morbidity and mortality
MRCP
Advantages
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Offers exquisite anatomical detail of the intrahepatic and extrahepatic biliary tree and pancreatic ducts
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Does not expose patients to ionizing radiation
Disadvantages
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Expensive
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Time consuming
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Requires significant patient cooperation to minimize artifact
VI. What are the contraindications for the alternative imaging techniques?
MR of the abdomen and pelvis with IV contrast
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Contraindicated in patients with non–MR-compatible hardware
Ultrasound
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No specific contraindications exist
ERCP
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Contraindicated in patients with a severe hypocoagulable state
MRCP
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Contraindicated in patients with non–MR-compatible hardware
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