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Ulak N, Bharati M, Bhattarai S, Ranjit PS, Byanju R. Agenesis of Dorsal Pancreas in a Young Adult: A Case Report. JNMA J Nepal Med Assoc 2023; 61:825-827. [PMID: 38289772 PMCID: PMC10579776 DOI: 10.31729/jnma.8304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Dorsal agenesis of the pancreas is an exceedingly rare congenital anomaly where the dorsal part of the pancreas fails to develop properly during embryonic development. We report a case of partial agenesis of the dorsal pancreas in a 27-year-old female who presented with progressively worsening abdominal pain, nausea, vomiting, generalized weakness, easy fatigability, and dizziness. Physical examination revealed fair general condition with stable vital signs and normal abdominal and other system findings. Laboratory evaluations and abdominal computed tomography scan revealed an absence of the pancreatic body, tail, and duct of Santorini, confirming the diagnosis of partial agenesis of the dorsal pancreas. Only around 100 cases have been reported in the literature, making it a diagnostic challenge. Our case illustrates the rarity and challenges in diagnosing dorsal agenesis of the pancreas. Further research is needed to fully understand its causes and associations. Keywords agenesis; case reports; congenital; pancreas.
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Affiliation(s)
- Nistha Ulak
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Manjil Bharati
- Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Suju Bhattarai
- Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Philip Shyam Ranjit
- Department of Internal Medicine, B&B Hospital Pvt. Ltd, Gwarko, Lalitpur, Nepal
| | - Rabina Byanju
- Department of Internal Medicine, B&B Hospital Pvt. Ltd, Gwarko, Lalitpur, Nepal
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Lalchandani A, Maurya A, Rizvi SFM, Yadav A. Agenesis of the Dorsal Pancreas: A Rare Cause of Diabetes and Recurrent Upper Abdominal Pain. Cureus 2023; 15:e34689. [PMID: 36909095 PMCID: PMC9994769 DOI: 10.7759/cureus.34689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/08/2023] Open
Abstract
Agenesis of the dorsal pancreas is a rare congenital disorder with only a handful of cases described in the literature. It presents a diagnostic dilemma. Cross-sectional imaging is the cornerstone for diagnosis. It could have a syndromic association with polysplenia and cardiac anomalies. Pancreas divisum and chronic pancreatitis may present with similar symptoms and must be ruled out. We present a case of a 55-year-old male with recurrent non-specific abdominal pain and diabetes mellitus. He was managed with insulin and painkillers for symptomatic relief. We also reviewed approximately 68 cases described in the literature to date.
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Affiliation(s)
- Ankit Lalchandani
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Ajeet Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | | | - Amit Yadav
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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3
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Kumar CB, Simon B, Simon E. An unusual case of steatorrhea. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2020. [DOI: 10.4103/jcrsm.jcrsm_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chaudhary P, Arora MP. Agenesis of Dorsal Pancreas with Eventration of Diaphragm and Intrapancreatic Pseudocyst: A Rare Entity. Clin Pract 2013; 3:e7. [PMID: 24765500 PMCID: PMC3981226 DOI: 10.4081/cp.2013.e7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/06/2012] [Accepted: 12/06/2012] [Indexed: 01/03/2023] Open
Abstract
A case of acute pancreatitis in a 43-year-old male patient, which was eventually diagnosed as agenesis of dorsal pancreas with eventration of left hemidiaphragm and intrapancreatic pseudocyst is being reported.
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Jarikji Z, Horb LD, Shariff F, Mandato CA, Cho KWY, Horb ME. The tetraspanin Tm4sf3 is localized to the ventral pancreas and regulates fusion of the dorsal and ventral pancreatic buds. Development 2009; 136:1791-800. [PMID: 19403659 PMCID: PMC2680106 DOI: 10.1242/dev.032235] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2009] [Indexed: 12/25/2022]
Abstract
During embryogenesis, the pancreas develops from separate dorsal and ventral buds, which fuse to form the mature pancreas. Little is known about the functional differences between these two buds or the relative contribution of cells derived from each region to the pancreas after fusion. To follow the fate of dorsal or ventral bud derived cells in the pancreas after fusion, we produced chimeric Elas-GFP transgenic/wild-type embryos in which either dorsal or ventral pancreatic bud cells expressed GFP. We found that ventral pancreatic cells migrate extensively into the dorsal pancreas after fusion, whereas the converse does not occur. Moreover, we found that annular pancreatic tissue is composed exclusively of ventral pancreas-derived cells. To identify ventral pancreas-specific genes that may play a role in pancreatic bud fusion, we isolated individual dorsal and ventral pancreatic buds, prior to fusion, from NF38/39 Xenopus laevis tadpoles and compared their gene expression profiles (NF refers to the specific stage of Xenopus development). As a result of this screen, we have identified several new ventral pancreas-specific genes, all of which are expressed in the same location within the ventral pancreas at the junction where the two ventral pancreatic buds fuse. Morpholino-mediated knockdown of one of these ventral-specific genes, transmembrane 4 superfamily member 3 (tm4sf3), inhibited dorsal-ventral pancreatic bud fusion, as well as acinar cell differentiation. Conversely, overexpression of tm4sf3 promoted development of annular pancreas. Our results are the first to define molecular and behavioral differences between the dorsal and ventral pancreas, and suggest an unexpected role for the ventral pancreas in pancreatic bud fusion.
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Affiliation(s)
- Zeina Jarikji
- Laboratory of Molecular Organogenesis, Institut de Recherches Cliniques de Montréal, Montreal, QC H2W 1R7, Canada
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Abstract
Morphogenesis of the pancreas is a complex process; nevertheless, congenital anomalies are rare. At embryogenesis, the pancreas develops from the endoderm-lined dorsal and ventral buds of the duodenum. The ventral bud gives rise to the lower head and uncinate process of the pancreas; whereas, the dorsal bud gives rise to the upper head, isthmus, body, and tail of the pancreas. Rarely, developmental failure of the dorsal pancreatic bud at embryogenesis results in the agenesis of the dorsal pancreas--neck, body, and tail. Even rarer is the association of pancreatic tumors with agenesis of the dorsal pancreas. In addition to citing our case, we provide a comprehensive review on agenesis of the dorsal pancreas and its association with pancreatic tumors.
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Schnedl WJ, Piswanger-Soelkner C, Wallner SJ, Reittner P, Krause R, Lipp RW, Hohmeier HE. Agenesis of the dorsal pancreas and associated diseases. Dig Dis Sci 2009; 54:481-7. [PMID: 18618254 DOI: 10.1007/s10620-008-0370-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/03/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND Agenesis of the dorsal pancreas is a very rare congenital pancreatic malformation and is associated with some other diseases. METHODS A PubMed search revealed 53 cases of agenesis of the dorsal pancreas. RESULTS In 28 patients with this congenital malformation hyperglycemia was demonstrated, 27 had abdominal pain, 16 had pancreatitis, 14 had an enlarged or prominent pancreatic head visible on computed tomography, and in a few cases, polysplenia, which may occur with various congenital anomalies of visceral organs, was described. CONCLUSIONS Difficulties involved in obtaining a firm diagnosis have led to a variety of terms being used to describe this congenital disease. Diagnosis of agenesis of the dorsal pancreas is inconclusive without demonstration of the absence of the dorsal pancreatic duct. Here we describe the embryological development of the pancreas, the so-far known cases of agenesis of the dorsal pancreas with associated medical problems, and the diagnostic measures to find the right conclusions.
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Affiliation(s)
- Wolfgang J Schnedl
- Department of Internal Medicine, Medical University, Auenbruggerplatz 15, A-8036, Graz, Austria.
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Joo YE, Kang HC, Kim HS, Choi SK, Rew JS, Chung MY, Kim SJ. Agenesis of the dorsal pancreas: a case report and review of the literature. Korean J Intern Med 2006; 21:236-9. [PMID: 17249505 PMCID: PMC3891028 DOI: 10.3904/kjim.2006.21.4.236] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Partial or complete agenesis of the dorsal pancreas is a rare congenital anomaly that results from the embryological failure of the dorsal pancreatic bud to form the body and tail of the pancreas. To date, four cases have been reported in Korea. We report an additional case; a 25-year-old woman presented with diabetes mellitus and abdominal pain. Abdominal computed tomography (CT) revealed a normal-appearing pancreatic head, but the body and tail were not visualized. Endoscopic cholangiopancreatogram (ERCP) revealed a short pancreatic duct in the uncinate process and the head and the duct of Santorini draining into the minor papilla. Abdominal magnetic resonance imaging (MRI) findings were similar to the CT and ERCP results. The patient was diagnosed with partial agenesis of the dorsal pancreas by CT, ERCP and MRI.
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Affiliation(s)
- Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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10
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Karcaaltincaba M. CT differentiation of distal pancreas fat replacement and distal pancreas agenesis. Surg Radiol Anat 2006; 28:637-41. [PMID: 17033736 DOI: 10.1007/s00276-006-0151-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 08/28/2006] [Indexed: 10/24/2022]
Abstract
We aimed to describe CT signs useful for differentiation of distal agenesis from distal or dorsal pancreas lipomatosis. Multidetector CT (MDCT) studies of five patients with distal pancreas agenesis (n = 2), distal lipomatosis (n = 1), distal short pancreas (n = 1), and distal pancreatectomy (n = 1) were retrospectively reviewed. Agenesis of dorsal pancreas can be diagnosed by the absence of body and tail of pancreas. In the absence of distal pancreas, distal pancreatic bed can be filled by stomach or intestine (dependent stomach or dependent intestine signs), which abut splenic vein. Same findings can be seen in patients with distal pancreatectomy, however, splenic vein is absent in these patients. In case of distal lipomatosis abundant fat tissue is observed anterior to splenic vein. Dependent stomach and/or dependent intestine signs on MDCT imaging can allow differentiation of distal pancreas agenesis from distal lipomatosis obviating further diagnostic studies.
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11
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Ulusan S, Bal N, Kizilkilic O, Bolat F, Yildirim S, Yildirim T, Niron EA. Case report: solid-pseudopapillary tumour of the pancreas associated with dorsal agenesis. Br J Radiol 2005; 78:441-3. [PMID: 15845940 DOI: 10.1259/bjr/91312352] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Solid-pseudopapillary tumour of the pancreas is a rare benign or low-grade malignant epithelial tumour; its association with pancreatic dorsal agenesis has been reported only once before. We present the radiological and histological findings of a case of pancreatic solid-pseudopapillary tumour associated with total pancreatic dorsal agenesis. A 49-year-old woman presented with abdominal pain radiating to the back for several months. Radiological findings showed absence of the dorsal pancreas and an 8 cm x 6 cm diameter tumour arising from the head of the pancreas. She underwent successful complete resection of the tumour. Histopathology revealed a diagnosis of solid-pseudopapillary tumour.
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Affiliation(s)
- S Ulusan
- Department of Radiology, Baskent University Adana Teaching and Medical Research Centre, Adana, Turkey
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12
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Güçlü M, Serin E, Ulucan S, Kul K, Ozer B, Gümürdülü Y, Pata C, Coşar A, Gür G, Boyacioğlu S. Agenesis of the dorsal pancreas in a patient with recurrent acute pancreatitis: case report and review. Gastrointest Endosc 2004; 60:472-5. [PMID: 15332050 DOI: 10.1016/s0016-5107(04)01733-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mustafa Güçlü
- Department of Gastroenterology, Başkent University, Adana Teaching and Medical Research Center, Sk. No:6 Yüreğir, Adana, Turkey
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13
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Benya EC. Pancreas and biliary system: imaging of developmental anomalies and diseases unique to children. Radiol Clin North Am 2002; 40:1355-62. [PMID: 12479715 DOI: 10.1016/s0033-8389(02)00055-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The focus of this article is on the development of the pancreas and biliary system, with a review of the most common congenital anomalies affecting the pancreas and biliary tree, including pancreas divisum, annular pancreas, congenital shortening of the pancreas, and choledochal cysts. Additionally, biliary atresia and pancreatoblastoma--both diseases of the pancreas and biliary system that almost exclusively affect children--are considered, with a discussion regarding the clinical presentation and imaging appearances of these disorders.
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Affiliation(s)
- Ellen C Benya
- Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza #9, Chicago, IL, USA.
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14
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Park CM, Han JK, Kim TK, Choi BI. Fat replacement with absence of acinar and ductal structure in the pancreatic body and tail. J Comput Assist Tomogr 2000; 24:893-5. [PMID: 11105708 DOI: 10.1097/00004728-200011000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We report an unusual case of fat replacement of the pancreatic body and tail. Findings on contrast-enhanced computed tomography and ERCP could be confused with dorsal pancreas agenesis. Histopathologic examination of the resected specimen revealed massive fat replacement with complete absence of the acinar and ductal tissue and scattered islets of Langerhans.
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Affiliation(s)
- C M Park
- Department of Radiology, Seoul National University College of Medicine, Korea
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15
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Deignan RW, Nizzero A, Malone DE. Case report: agenesis of the dorsal pancreas: a cause of diagnostic error on abdominal sonography. Clin Radiol 1996; 51:145-7. [PMID: 8631173 DOI: 10.1016/s0009-9260(96)80277-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R W Deignan
- Department of Radiology, McMaster University Medical Centre, Hamilton, Canada
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16
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Schnedl WJ, Reisinger EC, Schreiber F, Pieber TR, Lipp RW, Krejs GJ. Complete and partial agenesis of the dorsal pancreas within one family. Gastrointest Endosc 1995; 42:485-7. [PMID: 8566643 DOI: 10.1016/s0016-5107(95)70055-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- W J Schnedl
- Department of Internal Medicine, Karl Franzens University, Graz, Austria
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17
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Klein WA, Dabezies MA, Friedman AC, Caroline DF, Boden GH, Cohen S. Agenesis of dorsal pancreas in a patient with weight loss and diabetes mellitus. Dig Dis Sci 1994; 39:1708-13. [PMID: 8050322 DOI: 10.1007/bf02087781] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- W A Klein
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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18
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Yorifuji T, Matsumura M, Okuno T, Shimizu K, Sonomura T, Muroi J, Kuno C, Takahashi Y, Okuno T. Hereditary pancreatic hypoplasia, diabetes mellitus, and congenital heart disease: a new syndrome? J Med Genet 1994; 31:331-3. [PMID: 8071961 PMCID: PMC1049809 DOI: 10.1136/jmg.31.4.331] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report on a Japanese family with hereditary pancreatic hypoplasia, diabetes mellitus, and congenital heart disease. The disease was apparently inherited as an autosomal dominant trait. The patients in this family had no major anomalies other than those of the heart and pancreas. To our knowledge, this combination has not previously been reported.
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Affiliation(s)
- T Yorifuji
- Department of Paediatrics, Tenri Hospital, Nara, Japan
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Wildling R, Schnedl WJ, Reisinger EC, Schreiber F, Lipp RW, Lederer A, Krejs GJ. Agenesis of the dorsal pancreas in a woman with diabetes mellitus and in both of her sons. Gastroenterology 1993; 104:1182-6. [PMID: 8462806 DOI: 10.1016/0016-5085(93)90290-s] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Complete agenesis of the dorsal pancreas has rarely been described. Complete agenesis of the dorsal pancreas in a female who developed insulin-dependent diabetes mellitus at the age of 39 years is reported. The diagnosis of agenesis of the dorsal pancreas was suspected by abdominal ultrasound and confirmed by abdominal computed tomography (CT), magnetic resonance imaging, and endoscopic retrograde pancreatography. Her exocrine pancreatic function was essentially normal. Both of the patient's sons also had agenesis of the body and tail of the pancreas verified by abdominal CT but had no evidence of diabetes mellitus. This familial occurrence of agenesis of the dorsal pancreas suggests that hereditary mechanisms may play a role in the pathogenesis of this anomaly.
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Affiliation(s)
- R Wildling
- Department of Radiology, Karl Franzens University, Graz, Austria
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