Acute on chronic pancreatitis

Case contributed by Assis Prof Faeze Salahshour

Presentation

Known case of diabetes Mellitus with a history of recurrent epigastric pains now is referred because of a recent episode of epigastric pain.

Patient Data

Age: 20 years
Gender: Male

Evidence of previous cholecystectomy and hepatosteatosis is seen. Mild peripancreatic fat stranding is noted in favor of acute pancreatitis. Three calcified stones are visible within the pancreatic duct at the neck with dilation of the distal main pancreatic duct suggestive of chronic pancreatitis. The proximal pancreatic duct in the head appears normal. A small hypo-enhancing area in the pancreatic tail may represent necrosis. No fluid collection or biliary dilation depicted.

Annotated image

The blue and black arrows point to dilated main pancreatic duct and peripancreatic minimal fat stranding, respectively. The red arrow depicts the stones.

Case Discussion

The imaging findings of mild or interstitial pancreatitis may be absolutely subtle or even normal. Minimal fat stranding in transverse mesocolon or mesenteric root may be the only CT finding. Dilation of main pancreatic duct and stone formation within it is features of chronic pancreatitis. The pancreatic atrophy could be absent in the early stages and be a late finding.

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