Figure 1: (a) Ultrasound abdomen demonstrates hyperreflective pancreas, indistinguishable from normal retroperitoneal fat; (b and c) contrastenhanced axial CT images demonstrate atrophic pancreas with total fat replacement. The entire pancreas has low attenuation value (HU = −120). Main pancreatic duct appears to be stenotic (rather than dilated), suggesting chronic severe obstruction; (d) noncontrast axial CT image shows solitary calculus in distal pancreatic duct near the ampulla of Vater; and (e) contrastenhanced axial CT image demonstrates mildly dilated small bowel loops with wall thickening and dilution of contrast medium