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Moderate dilatation of the common bile duct till its lower end with no intraluminal stones on CT basis. The duodenal papilla (ampulla of Vater) is enlarged and edematous showing target appearance with submucosal edema and mild enhancement. It is measuring 2 x 2 cm in axial dimensions. No suspicious thickening or enhancement noted at the adjacent duodenal wall. Normal CT features of the pancreas.
Moderate intrahepatic biliary dilatation. Cholecystectomy clips are noted.
The pancreatic duct is not dilated and opens separately at the second part of the duodenum.
This case with a remote history of cholecystectomy represents features of acute obstructive jaundice with no intraluminal obstructing etiology and bulging duodenal papilla with mural stratification and mild enhancement that is most likely representing papillitis. Endoscopy showed enlarged duodenal papilla with inflammation and performed endoscopic sphincterotomy.
The normal major duodenal papilla can barely be distinguished from the surrounding duodenal mucosal folds. It appears as a protuberance less than 10 mm in diameter with enhancement comparable to that of the adjacent duodenal mucosa.
Duodenal papillitis is an inflammation that can present due to infection, parasites, recently passed stone, choledocholithiasis, impacted ampullary stone, periampullary diverticulum and can occur in conjunction with acute cholangitis, acute pancreatitis, or acute exacerbation of chronic pancreatitis.(1)
The inflamed papilla usually displays symmetric thickening (> 5~10 mm) with homogeneously increased enhancement and mural stratification in the form of target-like enhancement. This finding helps distinguish benign papillitis from hypovascular malignant conditions on CT.(1)