CT Imaging of Acute Pancreatitis

CT Imaging of Acute Pancreatitis
Presentation by:Erin Rikard

Outline
* Definition
* Epidemiology
* Causal Factors
* Pathophysiology
* CT Evaluation and Findings – Normal and abnormal
* Complications
* Management
* Prognosis

Definition
Acute Pancreatitis - Inflammation of pancreas with potential for complete healing
Epidemiology
Causal Factors
Incidence
Cholelithiasis
Trauma/Surgery
Metabolic Disorders
Viral Infection
Pathophysiology
* Pancreatic autodigestion, with activated pancreatic enzymes escaping the ductal system and lysing tissue of pancreas and adjacent structures
* Lack of capsule facilitates spread
Normal CT Findings
Normal Anatomy by CT
* Pancreas arcing anteriorly over spine
* Head adjacent to duodenum
* Tail extending toward spleen
* Splenic vein posterior to body and tail
* Portal vein confluence immediately posterior & left of pancreatic neck

Normal Morphology by CT
Evaluation by CT
Evaluation of Acute Pancreatitis
* Contrast-enhanced CT is imaging modality of choice
* Oral and IV contrast differentiate pancreatic tissue from adjacent blood vessels and duodenum
Recommendations for Contrast-Enhanced CT
* Clinical diagnosis in doubt
* Severe clinical pancreatitis
* Ranson score > 3
* APACHE score > 8
* Failure to rapidly improve within 72 hours of beginning conservative medical therapy
* Initial improvement with later deterioration

Ranson Criteria
Abnormal CT Findings
* Peripancreatic inflammation
* Diffuse or focal pancreatic edema
* Poor definition and heterogeneity of gland
* Fluid collections
* Necrosis
* Thickening of pararenal fascia

Spectrum of Disease
* Mild Cases
* Severe Cases
Peripancreatic Inflammation/ Pancreatic Edema/Fluid Collections
Infection?
Necrosis
Complications
* Pancreatic Pseudocysts
* Abscess
* Hemorrhagic Pancreatitis
* Splenic Artery Pseudoaneurysm formation or rupture/ Splenic Venous Thrombosis

Pancreatic Pseudocyst
* Fluid collection surrounded by fibrous capsule but not lined by epithelium
* Occurs in 10% of cases
* Significant % will not resolve spontaneously
* Seen within pancreas and potential spaces with which gland is continuous (lesser sac and left pararenal space)
Abscess
Hemorrhagic Pancreatitis
Splenic Artery Pseudoaneurysm
Management
Prognosis
Reasons for Reduced Mortality
Resources

CT Imaging of Acute Pancreatitis.ppt