Acute necrotizing pancreatitis with abscess formation
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History :
This 40 y/o gentalman had abdominal distension and pancreatic enzyme elevation. Dehydration and electrolyte imbalance was also noted.
Image finding :
Abdominal CT showed pancreatic pseudocyst formation and infected necrotizing pancreatitis was impressed.
Diagnosis :
Acute necrotizing pancreatitis with abscess formation
Discussion :
NECROTIZING PANCREATITIS: proteolytic destruction of pancreatic parenchyma; mortality rate of 80-90%
HEMORRHAGIC PANCREATITIS: + fat necrosis and hemorrhage
(b)SUPPURATIVE PANCREATITIS: + bacterial infection
- Diffuse pancreatitis (52%)
- Focal pancreatitis (48%): location of head:tail = 3:2
Abdominal film:
"colon cutoff" sign = dilated transverse colon with abrupt change to a gasless descending colon (inflammation via phrenicocolic ligament causes spasm + obstruction at the splenic flexure impinging on a paralytic colon)
CT findings in pancretitis (pancreatic visualization in 98%):
-no detectable change in size / appearance (29%)
-hypodense (5-20 HU) mass in phlegmonous pancreatitis; may persist long after complete recovery
-hyperdense areas (50-70 HU) in hemorrhagic pancreatitis for 24-48 hours
-enlargement with convex margins + indistinctness of gland with parenchymal inhomogeneity
-thickening of anterior pararenal fascia
-non-contrast-enhancing parenchyma during bolus injection (= pancreatic necrosis)
