Acute necrotizing pancreatitis

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Severe abdominal pain, distension and jaundice.

Patient Data

Age: 60 years
Gender: Male
  • The pancreas is diffusely and massively enlarged with a multifocal cystic collection demonstrating low T1 and high T2 signal intensity with the largest pocket of 8 X 6 cm as well as multiple gas loculi with signal voids denoting infected pancreatic necrosis.
  • Peripancreatic fluid collection as well as peripancreatic fat stranding and small enlarged peripancreatic lymph nodes.
  • The pancreatic lesion is associated with compression of the distal CBD with proximal CBD as well as central intra-hepatic ducts dilatation.
  • Mild ascites as well as minimal bilateral pleural effusions.
  • The gallbladder shows a small signal void of gallstones.
  • No evidence of CBD stones.
  • The liver is average sized with a smooth regular outline, no definite focal hepatic lesion.
  • A left renal lower pole 5 X 5 cm simple cortical cyst. 

 

CT confirmed acute necrotizing pancreatitis with multifocal cystic collections and gas densities with peripancreatic fluid collection and inflammatory fat stranding.

Case Discussion

  • The above described findings are those of acute necrotizing pancreatitis with peri-pancreatic fat stranding and fluid collection as well as peri-pancreatic lymphadenopathy with mild dilatation of CBD and proximal intra-hepatic biliary radicles dilatations.
  • Mild ascites and small bilateral pleural effusions.
  • Gall bladder stones. No evidence of choledocholithiasis.

 

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