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