Acute pancreatitis

Abstract

Both CT and sonography are useful in imaging of patients with acute pancreatitis (Table 1). Contrast-enhanced CT identifies pancreatic necrosis as intraglandular non-enhancing regions. These patients require prophylactic antibiotics. CT can identify complications and guide intervention when appropriate. All patients, even alcoholics, with acute pancreatitis, require sonography, to detect gallstones and biliary obstruction. Understanding sonographic findings in acute pancreatitis can allow diagnosis in clinically unsuspected cases. In an unpublished retrospective study, we found abnormalities in 94% of patients with acute pancreatitis. Common abnormalities include glandular heterogeneity (60%), peripancreatic and retroperitoneal inflammation (60%), and focal hypoechoic abnormalities (25%). The pancreas is diffusely hypoechoic in less than 50% of patients. Pancreatic enlargement in acute pancreatitis is probably almost universal, but difficult to judge, as pre-pancreatitis size is usually unknown and varies widely. We use 22 mm as the normal upper limit AP measurement of the pancreatic body at the level of the SMA. Acute pancreatitis-associated fluid collections are frequent and evanescent. Fluid collections that persist for 6 weeks are called pseudocysts. Table 1. Imaging in acute pancreatitis ultrasound: 1) detect gallstones as a cause of acute pancreatitis (ALL first-time patients); 2) detect bile duct dilatation and obstruction; 3) diagnose unsuspected acute pancreatitis; 4) follow known fluid collections; 5) guide aspiration and drainage CT; 6) confirm uncertain diagnosis of acute pancreatitis; 7) detect pancreatic necrosis (patients with suspected severe pancreatitis); 8) detect other complications of acute pancreatitis; and 9) guide aspiration and drainage.