While reading any case of acute pancreatitis the checklist should include:
- Balthazar grading
- possible cause of pancreatitis
Bear in mind that the patient may present late, not in the acute stage of pancreatitis (complications have occurred). Necrosis usually occurs 48 hours following the acute attack of pancreatitis.
Here we have a case of complicated pancreatitis. A large collection is replacing the body and tail of the pancreas. It contains fluid attenuation with internal debris (nonenhancing; necrotic) and multiple air loculi (possible infection).
There is also chronic thrombosis of the splenic vein with a stenosed splenomesenteric confluence. This results in segmental portal hypertension and gastric varicosities. An important pertinent negative item would be showing that there is no splenic artery aneurysm. In this case the splenic artery shows normal caliber and patency.
No related mass lesions. However, there is multiple gallstones.
The case is courtesy of Prof Dr. Mohammed Eid, Alexandria University Egypt