Acute pancreatitis with incidental pancreatic lipoma

Case contributed by Hani Makky Al Salam


Abdominal pain and high lactate.

The pancreas is swollen, associated with extensive peripancreatic stranding and fluid in the lesser sac, extending to the pararenal spaces, more on the left side, with minimal perisplenic and perihepatic free fluid. A very small part of the head of the pancreas appears to be less enhancing compared to the rest of the gland suspicious for necrosis. No gas locule can be seen in the pancreas. No walled off collection or pseudocysts can be seen. 

There is a small hypodense, well-defined, non-enhancing lesion seen in the tail of the pancreas. 

Gallbladder contains radiopaque stones in the neck, with no CT features of acute cholecystitis. The celiac and SMA are patent. No splenic artery pseudoaneurysm. 

Portal, splenic and superior mesenteric veins are patent, with no evidence of thrombosis. 

Left sided pleural effusion (minimal) and associated basal collapse/consolidation. 

Interpretation: Features of acute pancreatitis, likely due to cholelithiasis. A small hypoenhancing pancreatic head portion is suggestive of necrosis. Small, non-enhancing hypodense pancreatic tail lesion could represent a small cyst (pseudocyst is though less likely given the timing of the CT since the symptoms) or other lesions, such as lipoma, but needs further evaluation once the patient clinically improves. 

Gallstones are noted. The visualized head of the pancreas is hypoechoic and swollen.

Acute pancreatitis.

Gallstones are noted. Multiple gallstones are also noted along the dilated CBD (choledocholithiasis) with mild intrahepatic biliary dilatation.

Loss of signal in the pancreatic tail lesion on the opposed phase sequence, as seen on the CT, in keeping with pancreatic lipoma

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.