Presentation
Abdominal pain.
Patient Data
Extensive regions of the pancreatic head and body show poor enhancement and are replaced by a large fluid density collection, consistent with necrosis. The pancreas is enlarged and edematous, with surrounding fat stranding and fluid tracking in the anterior pararenal spaces bilaterally and also extending into the pelvis.
These features are in keeping with severe necrotizing pancreatitis. There are peritoneal free fluid and bilateral pleural effusions. No radiopaque gallstones or biliary dilatation.
Cholecystectomy has been performed since the previous CT. The previously shown region of acute necrotic fluid has evolved into a more homogeneous fluid collection with a defined wall, with further small cystic components extending along the left retroperitoneum. The collection causes narrowing of the splenic vein, although the portal, splenic and superior mesenteric veins remain patent. There is minimal remaining enhancing pancreas a the tail.
Case Discussion
This case illustrates evolution of acute necrotizing pancreatitis, from acute necrotic collection on its way to becoming walled-off necrosis.