E2004. Get Your Ducts in a Row: Congenital Pancreaticobiliary Tract Anomalies
  1. Nolan Fenzl; University of Rochester Medical Center
  2. Ravinder Sidhu; University of Rochester Medical Center
The pancreaticobiliary tract is one of the most frequently and diversely imaged organ systems in the body due to its high clinical and procedural relevance. The radiologist often diagnoses pancreaticobiliary pathology directly, and also identifies variant anatomy that can carry operative implications and assist with more complicated clinical diagnoses. Many clinicians also play a role in imaging diagnoses of pancreaticobiliary pathology, such as gastroenterologists and hepatobiliary surgeons. The purpose of this presentation is to focus on relevant common and uncommon pancreaticobiliary anatomy for the radiologist to effectively identify for providers.

Educational Goals / Teaching Points
1. Review the embryologic development of the pancreaticobiliary tract and “normal” anatomy. 2. Discuss the multimodal imaging techniques that are most commonly used to assess the pancreaticobiliary tract. 3. Highlight important variant anatomy that could be encountered by radiologists and providers alike. 4. Describe relevant pancreaticobiliary pathologies and their respective clinical implications in an illustrative case-based manner.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1. Embryology of the pancreaticobiliary tract. 2. Pancreaticobiliary anatomy. 3. Hepatic biliary variant examples such as the duct of Luschka, cystic ductal variant examples such as a long cystic duct, and pancreatic ductal variant examples such as Ansa pancreatica. 4. Demonstrate these variations by utilizing examples derived from multimodal imaging techniques such as CT, MRCP, ERCP/cholangiography, HIDA, and ultrasound. 5. Discuss the important clinical relevance of these variations with multiple case based examples such as cases of recurrent pancreatitis and bile leak post cholecystectomy.

Pancreaticobiliary pathology is diagnosed by utilizing different imaging modalities and with collaboration across multiple specialties. As an important part of this collaborative effort, the radiologist must be aware of variant anatomy and its imaging manifestations so as to best aid in clinical decision making. Developing this knowledge is therefore critical in reducing patient morbidity and optimizing patient care.