Fig. 1

Imaging findings. a Abdominal multidetector-row computed tomography (MDCT) at the referral hospital. A hypovascular tumor was present in the body of the pancreas (arrow), and the distal pancreatic duct was dilated. In addition, a slightly low-density area (LDA) was found to be spread over the ventral side of the pancreas (arrowhead) and touching the stomach. b MDCT images obtained 2 months later at our hospital. There was no significant change in the tumor size (arrow) or pancreatic duct dilatation, but the LDA at the ventral side of the pancreas had shrunk (arrowhead). The two-tone duct sign and cork-of-wine-bottle sign were observed (arrow). Retrospective examination revealed findings that seemed to indicate the rupture of the main pancreatic duct (MPD) and the formation of a fistula extending outside of the pancreas (black arrow). c T2-weighted magnetic resonance image taken at our hospital. Constriction of the MPD (arrow) and distal MPD dilatation (arrowhead) was observed, but the tumor was unclear. d Positron emission tomography-computed tomography taken at the referral hospital. Weak accumulation of fluorodeoxyglucose was present at the ventral side of the pancreas, corresponding to the LDA on MDCT (arrowhead); however, no apparent accumulation was noted in the tumor (arrow)