Fig. 5
In a 63-year-old female with idiopathic chronic pancreatitis (CP) and parenchymal thinning long neck, body and tail of the pancreas, contrast-enhanced MDCT (axial image a, oblique reformation along MPD in b) showed diffusely dilated (maximum caliber 9 mm) MPD (arrows) upstream to a distal, densely calcified stone (thin arrows) measuring approximately 1.5 cm. MRCP (c) confirmed large intraductal stone as signal void (thin arrow) at distal MPD causing upstream obstruction. Endoscopic fragmentation (d) was unsuccessful due to impeded passage of guidewire, so the patient underwent extracorporeal shock wave lithotripsy (adapted from Open Access ref. no. [28])