Hepatobiliary and pancreatic: Man with recurrent jaundice and abdominal pain

A 31-year-old man presented with a history of two episodes of jaundice associated with severe right upper quadrant abdominal pain during the past 3 years. He had one episode of jaundice at the age of 3 years. He was asymptomatic at presentation. His physical examination was normal. Liver function tests were normal except for serum aspartate aminotransferase at 44 IU/L (normal < 40 IU/L). Serum amylase was normal and an ultrasound of the abdomen did not reveal any pathology. On endoscopic retrograde cholangiopancreatography, only a pancreatogram could be obtained as shown in Fig. 1. A magnetic resonance imaging scan (T1-weighted phase axial imaging) of the abdomen ( Fig. 2) and magnetic retrograde cholangiopancreatography ( Fig. 3) were also performed. Questions: What is your diagnosis? What are the findings noted in these films? See commentary on page 456