Hemorrhagic pancreatitis
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Shah V, Hartung M, et al. Hemorrhagic pancreatitis. Reference article, Radiopaedia.org (Accessed on 26 Jan 2025) https://doi.org/10.53347/rID-17667
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rID:
17667
Article created:
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosures
Revisions:
16 times, by
14 contributors -
see full revision history and disclosures
Systems:
Synonyms:
- Haemorrhagic complicating pancreatitis
- Pancreatitis complicated by haemorrhage
- Hemorrhagic pancreatitis
- Pancreatitis complicated by hemorrhage
Hemorrhagic pancreatitis is characterized by bleeding within or around the pancreas, and is usually considered a late sequela of acute pancreatitis.
Pathology
Hemorrhage can occur in patients with severe necrotizing pancreatitis or as a result of pancreatic pseudoaneurysm rupture when it constitutes a life-threatening emergency.
Etiology
According to one study, the usual causes of hemorrhage were 2:
- bleeding pancreatic pseudoaneurysm or peripancreatic pseudoaneurysm: ~60%
- diffuse bleeding with pancreatic necrosis: ~20%
- hemorrhagic pancreatic pseudocysts: ~20%
Radiographic features
CT
Acute hemorrhage typically has high attenuation on unenhanced CT scans. The attenuation value then decreases as the hematoma ages through time 5.
MRI
Hemorrhagic fluid collections are more evident on MRI than CT due to the following reasons 1:
- T1: high-signal intensity methemoglobin
- T2: low-signal intensity hemosiderin rim
Signal abnormalities due to hemorrhage remain visible longer on MRI than on CT.
References
- 1. Miller FH, Keppke AL, Dalal K et-al. MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol. 2004;183 (6): 1637-44. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology. 2001;1 (4): 306-13. - Pubmed citation
- 3. Ammori BJ, Madan M, Alexander DJ. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management. Ann R Coll Surg Engl. 1998;80 (5): 316-25. - Free text at pubmed - Pubmed citation
- 4. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223 (3): 603-13. doi:10.1148/radiol.2233010680 - Pubmed citation
- 5. Sahni VA, Mortelé KJ. The bloody pancreas: MDCT and MRI features of hypervascular and hemorrhagic pancreatic conditions. AJR Am J Roentgenol. 2009;192 (4): 923-35. doi:10.2214/AJR.08.1602 - Pubmed citation
- 6. Vujic I. Vascular complications of pancreatitis. Radiol. Clin. North Am. 1989;27 (1): 81-91. - Pubmed citation
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