Acute Pancreatitis (Part Two)
Fig 4: CT scan examination showing a pseudocyst in the body and tail of the pancreas.
Fig 3: Ultrasound examination showing a pseudocyst in the head of the pancreas
CT data in acute pancreatitis
- Diffuse enlargement of the pancreas
- Its contours are deformed
- Gerota's fascia thickens and the density of the peripancreatic adipose tissue increases
- Focal thickening of the stomach walls, this sign is found in 70% of cases with acute pancreatitis.
Complications of acute pancreatitis
- Pancreatic pseudocyst: an oval or round, encapsulated pancreatic fluid collection, surrounded by a distinct fibrous capsule: requires at least 4 weeks to form: the dimensions of the pseudocyst walls are more accurately determined by CT.
- Hemorrhagic pancreatitis: as a result of erosion of vessels and tissue necrosis. In CT, we have blood (with high density) in the retroperitoneum.
- Abscesses: a confined collection of pus with or without tissue necrosis. Appears as a fluid collection with a thick capsule. They develop in 4% of cases with acute pancreatitis. A characteristic sign in CT is the presence of gas in the pancreas or peripancreatic. The gas is formed by gas-forming bacteria. If gas is not present, then it is not easy to distinguish the pseudocyst from the abscess. In these cases, the final diagnosis is made through the aspiration of the content with a thin needle.
- Pseudoaneurysm: autodigestion of the arterial wall by pancreatic enzymes, resulting in a pulsating mass, surrounded by fibrous tissue and maintains communication with the artery of origin.
- Liquid necrosis of the pancreatic parenchyma that in CT with IV contrast bolus we have absence of parenchymal enhancement, sometimes and multifocal.
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