FOCAL NECROTIZING PANCREATITIS PRESENTING AS
PAGE KIDNEY
Dr. Momin Mohammad AmerDr. Aniruddha KulkarniDr. Shubhangi Shetkar
Dr. Neeta Kadam
TAPADIA DIAGNOSTIC CENTRE, Aurangabad.Maharashtra.
CLINICAL HISTORY
• 25 year / male , chronic alcoholic
• Presented with pain in left hypogastric region• Recent onset of hypertension
• No h/o trauma
• Lab investigations - White blood cell count 11 900 × 109
C‐reactive protein 169 mg/l Serum amylase 120 U/l
Serum lipase 86 U/l
USG – Left perinephric anechoic collection causing distortion of left renal parenchyma
CECT abdomenLeft kidney : • distorted , displaced antero-superiorly
• large, sub-capsular, perinephric collection maximum depth of 95 mm
Post contrast coronal section
Left renal pelvis and vascular pedicle compressed
Delayed coronal Early sagittal
• Pancreatic tail bulky ~ 20 mm • Loss of acinar pattern, heterogeneous
post contrast enhancement
• Non enhancing, hypodense, necrotic areas within tail.
• Main pancreatic duct at tail region dilated ~ 7 mm
• Minimal peri-pancreatic fat stranding
• Head, uncinate process and body of pancreas unremarkable Curved MPR coronal section
Connection between sub-capsular collection and pancreatic tail necrosis
Curved MPR axial and sagittal
DIAGNOSIS - Focal necrotizing pancreatitis of tail resulting in left page kidney.
Page kidney - Phenomenon of hypertension that develops following long-standing compression of renal parenchyma by sub-capsular renal collection.
Compression of renal parenchyma
Compression of renal vessels
Decreased renal blood flow
Activation of Renin- angiotensin system
Rise in B.P. (Secondary hypertension)
REFERENCES Diagnostic Radiology, A Textbook of Medical Imaging Grainger
and Allison's 4t edition, Vol. 2, P.No. 1088, 1303-04. Chowdhury P, Gupta P. Pathophysiology of alcoholic
pancreatitis: An overview. World J Gastroenterol 2006;12:7421-7
Diagnostic ultrasound, IInd Edition Vol. One P.No. 199-202. Carol M. Rumack/Stephenic R. Wilson, J. William Charbonean
Balthazar EJ, Fisher LA. Frey C. Hemorrhagic complication of pancreatitis: radiological evaluation with emphasis on CT Imaging. Pancreatology 2001;1(4): 3006-3013
