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Necrotizing pancreatitis with acute necrotic collections

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Four days of left upper quadrant and episgastric pain with nausea.

Patient Data

Age: 40 years
Gender: Male

The pancreatic body and tail is edematous with surrounding fat stranding. An post contrast imaging there are areas of non-enhancing pancreas within the body in keeping with small areas of necrosis. In the left upper quadrant there I extensive multiloculated collections which appear well retroperitoneal. One of the collections extends into the left diaphragmatic crus. 

Prominent portal and splenic veins have developed since the prior CT. Para-esophageal soft tissue density – lymph node vs. varices. Liver, spleen, adrenal glands, kidneys and gallbladder are unremarkable. Bowel is unremarkable. Reactive thickening of the posterior stomach wall. Trace pelvic free fluid. Lung bases are clear. No suspicious bony lesion.

Case Discussion

Necrotizing pancreatitis is a severe form of pancreatitis, and can be complicated by acute necrotic collections / walled-off necrosis

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