Presentation
Day three after onset presentation and admission due to upper abdominal pain. Elevation of amylase and lipase.
Patient Data
Acute necrotic collection (ANC) in the pancreatic tail with surrounding retroperitoneal inflammatory changes, predominantly characterized by diffuse phlegmon and necrotic collections. Fluid in the anterior pararenal spaces tracks down until the pelvis. There is no lymph node enlargement. The liver, spleen, kidneys and adrenal glands are normal. Reactive enhancement of the common bile duct. Diffuse reactive duodenal thickening as well as mild colonic wall thickening.
There is mild dilatation of the proximal jejunum, likely reactive. No free gas. No suspicious bone lesions are seen. Bilateral small pleural effusion and associated restrictive atelectasis. Small pericardial effusion.
Case Discussion
The non-enhancing low attenuating regions within the pancreatic tail, involving more than 30% of its parenchyma, compatible with acute necrotic collections (ANCs). Features are those of severe pancreatitis accordingly to the CT severity index.
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