Presentation
Severe abdominal pain.
Patient Data
A 32×6 mm fluid collection is seen at the antero-inferior aspect of the pancreatic body.
There is an ill defined unenhanced area in the body of the pancreas in favor of necrosis.
The fat plane between body of pancreas and gastric antrum is obliterated and wall thickening is seen at antrum. Peripancreatic fat stranding is noted. Features are most compatible with necrotizing pancreatitis.
A few tiny cyst are seen at right hepatic lobe.
Pancreatic head is enlarged and there is parenchymal volume loss at pancreatic neck and body most compatible with sequel of prior necrotizing pancreatitis. Peripancreatic fat stranding is present. No pseudocyst or fluid collection in current study.
Several small hypo-attenuating lesions measuring less than 8 mm are seen in the liver which show no obvious enhancement on delayed images most consistent with cysts.
The gallbladder is not seen at anatomical location due to prior resection.
Mild pneumobilia is present in the left liver lobe.
The prostate gland is enlarged.
Degenerative changes as osteophytosis are seen at the lumbar spine.
Case Discussion
Features on first CT scan and follow up images are compatible with necrotizing pancreatitis. It is considered a subtype of acute pancreatitis as necrosis usually tends to occur early, within the first 24-48 hours, but can also rarely occur with subacute forms.