imaging of acute pancreatitis

7/21/2019 Imaging Of Acute Pancreatitis

http://slidepdf.com/reader/full/imaging-of-acute-pancreatitis 1/25

Dwiva Wulan Guri

11-086

Imaging Of Acute Pancreatitis



Denition Te clinical !enition of acute "ancreatitis

re#uires two of te following features$

%1& A'!ominal "ainstrongl( suggestive of

acute "ancreatitis)

%*& +erum am(lasean!,or li"ase activit(at least tree times

greater tan te u""er

limit of normal%& caracteristicn!ings of acute"ancreatitis onimaging.



PaseAcute "ancreatitis is caracterise! '( two

!istinct "ases$

/arl( or interstitial"ase lasts

a""roimatel( 1wee an! is

!ominate! '( a

s(stemicin2ammator(

res"onse.

+econ! "ase"ancreatic

in2ammationresolves3 sta'ilisesor "rogresses into

necrotising"ancreatitis tatcan last wees or

monts.



Pato"isiolog(Acute "ancreatitis can 'e consi!ere! in two !istinct

"ases. Te rst "ase usuall( lasts a'out a wee an!is !ominate! '( te s(stemic in2ammator( res"onses(n!rome %+I4+& cause! '( te release ofin2ammator( me!iators in res"onse to tissue in5ur(.

Disease severit( is associate! wit organ !amage an!is relate! to te s(stemic in2ammator( res"onserater tan te etent of "ancreatic necrosis. Duringtis "ase "atient assessmentis 'ase! on clinicalin!icators rater tan imaging. In te secon! "ase

te "ancreatic in2ammation ma( resolve3 sta'ilise or"rogress to necrotising "ancreatitis tat can run a"rotracte! course lasting wees or monts.



Imaging Tecni#ues



/sta'lis te

!iagnosis3 I!entif( aetiolog(

Assess an(com"lication

Te role ofimaging is

treefol!



T tecni#ueImages are o'taine! using contrast-

enance! T %/T&3 aiming for o"timalvascular an! "arenc(mal enancementwit minimal res"irator( motion artefact.

Te !iagnosis of necrotising "ancreatitis!e"en!s on an assessment of "ancreatic"arenc(mal enancement.

An evaluation ma!e easier '( com"aring"re- an! "ost-contrast images.



/sta'ilis Te Diagnosis Te clinical !enition of acute "ancreatitis %weter

on a 'acgroun! of cronic "ancreatitis or not&re#uires two of te following tree features$ %1&a'!ominal "ain strongl( suggestive of acute"ancreatitis) %*& serum am(lase an!,or li"ase at least

tree times greater tan te u""er limit of normal)%& caracteristic n!ings of acute "ancreatitis onimaging %/T is te imaging tecni#ue of coice&.

Imaging is not usuall( re#uire! for !iagnosis 'ut weretere is clinical !ou't T can conrm acute"ancreatitis or o7er an alternative !iagnosis for te"atients "resentation.



/sta'ilising te aetiolog(

Gallstone !isease

Develo"mentala'normalities of te

"ancreatico'iliar( tree

Autoimmune"ancreatitis



Autoimmune "ancreatitis. Aial contrast-enance! T images *(ears a"art !emonstrate te rela"sing nature of tis !isease.Images sow !i7use enlargement of te "ancreas3 wic is of lowerattenuation tan e"ecte!3 an! !is"la(s a latticewor enancementaccom"anie! '( a "eri"eral rin! of low soft tissue attenuation.9ulti"le we!ge-sa"e! low attenuation lesions seen witin te renal

corte %arrows& re2ect renal involvement3 foun! in u" to :;"atients.



Imaging n!ings in acute

"ancreatitis



Aial T sowing enlargement of te"ancreas wit striing "eri-renal s"aringan! etra"ancreatic in2ammator(cange a7ecting te colon.

+evere acute"ancreatitis




Aial contrast-enance! T from a!i7erent "atient wit gallstone"ancreatitis sowing are!gastric ticening giving rise to

clinical gastric outlet o'struction%arrow&.




Te same "atient also sows

mare! colonic an! "roimalsmall 'owel wall ticening%arrows&



Pancreaticnecrosis

Pancreatitis secon!ar( togallstones. Aial T sowing

non-enancement of .0; of tenec an! 'o!( of te "ancreas3wit a stone seen in te !istalcommon 'ile !uct %arrow&.



Pancreaticnecrosis

Arterial "ase aial image from a"atientclinicall( tougt to ave a ru"ture!aortic aneur(sm. Arterial "ase image

sows glo'al ("o"erfusion of te"ancreas wit avi! enancement of tea!renal glan! %wite arrow& an! 2atinferior vena cava %'lac rrow&in!icative of te "atientsclinicall( soce! status.



Pancreaticnecrosis

9o!ie! coronal "ro5ection in arterial"ase sows te relative non-

enancement of te entire "ancreas3o'vious wen com"are! wit teenancement of te s"leen %witearrow&.



Peri Pancreaticnecrosis

aial contrast-enance! T sowing !i7use

enlargement of te "ancreas wit surroun!ingin2ammator( cange3 'ut no evi!ence of"arenc(mal necrosis. <owever3 tere isin2ammator( cange involving te "eri-"ancreatic fat wit a low soft tissue !ensit( rin!consistent wit "eri-"ancreatic necrosis %arrow&.



Infecte!"ancreaticnecrosis

Aial contrastenance! T sowsetensive gas formation at te site of"ancreatic necrosis wit no !iscerna'le2ui! com"onent an! free intra"eritonealgas tracing nteriorl( %arrow&.



Infecte! necrosis

ontrast-enance! aial T sowsmature 2ui! collection in an area of"revious necrosis containing foci of gasarrow&.



om"lication

=asular

Gastrointestinal



>lee! into a"ancreatic"seu!oc(st

is sown '( te ig attenuation 2ui!witin te c(st %arrow& tat coul! easil(ave 'een misse! on "ost-contrast



Pseu!oaneur(sm

large "seu!oaneur(sm tat a! stulate! into tesu"erior mesenteric vein an! conrme! atangiogra"( to 'e fe! from te gastro!uo!enalarter(. ?arge collateral vessels can 'e seen aroun!te !uo!enum %arrow&. Tis "atient was treate! '(covere! stenting of te !efect in te gastro!uo!enalarter(



onclusion

Imaging3 "re!ominantl( /T3 "la(s acentral role in te management of "atientswit acute "ancreatitis were assessmenton clinical groun!s alone can 'e etremel(

!i@cult.

imaging of acute pancreatitis

Documents