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Acute pancreatitis

Case contributed by Mohamed El Deen
Diagnosis almost certain

Presentation

Came to the ED complaining of acute epigastric pain referred to the back for the last 24 hours, with multiple episodes of vomiting and nausea over the last night.

Patient Data

Age: 35 years
Gender: Male
ct

There is diffuse parenchymal edema of the pancreas including head, body and tail.
There is also peritoneal fat stranding. No local complications of acute pancreatitis including fluid collections, pseudocyst formation, abscess, hemorrhage, venous thrombosis, and pseudoaneurysm formation. But after contrast injection, limited uptake in arterial phase raised the flag for tissue necrosis.

On the post-contrast arterial phase, there is a pancreatic heterogenous enhancement with non-enhancement area in the head and body.  "More clear in coronal images".

On portovenous phase, still decreased contrast uptake in some parts of the head of the pancreas is noted.

On delayed phase, complete wash out of the contrast is seen. 

Case Discussion

Edematous pancreas with associated fat stranding and characteristic epigastric pain radiating to the back are clear signs of acute pancreatitis. CECT is useful for early detection of any necrosis in the pancreatic tissue.  Ultrasound is always needed to rule out gall bladder stones even if not seen on CT scan.   

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