ERCP in a 45-year-old man with chronic alcoholism and recurrent pancreatitis shows a markedly dilated main pancreatic duct with alternating areas of stricture and dilatation, producing a characteristic 'chain-of-lakes' appearance. Side branches show clubbed dilatations. The MOST likely diagnosis is:

• A Pancreatic ductal adenocarcinoma
• B Autoimmune pancreatitis
• C Intraductal papillary mucinous neoplasm
• D Chronic pancreatitis ✓

Explanation

The 'chain-of-lakes' appearance (alternating strictures and dilatations of the main pancreatic duct with side-branch clubbing) is the classic ERCP finding of chronic pancreatitis. Adenocarcinoma causes abrupt duct cutoff without alternating strictures. Autoimmune pancreatitis shows long segmental narrowing without chain-of-lakes. IPMN shows mucin extruding from the ampulla and cystic side-branch dilatation rather than the chain-of-lakes pattern.

Reference: Textbook of Gastrointestinal Radiology (Gore), Standard edition ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.