Acute Pancreatitis - Spectrum of imaging findings based on the Revised Atlanta Classification

Congress:

ECR 2018

Poster Number:

C-3003

Type:

Educational Exhibit

Keywords:

Inflammation, Diagnostic procedure, CT, Pancreas, Abdomen

Authors:

R. M. Antunes, P. G. M. G. Ferreira; Lisbon/PT

DOI:

10.1594/ecr2018/C-3003

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-3003

Fig. 1: Contrast-enhanced CT performed 4 days after the onset of epigastric pain shows...

Fig. 2: Contrast-enhanced CT scan of the same patient of fig. 1 performed 16 days after...

Fig. 3: Contrast-enhanced CT scan of the performed 7 weeks after the onset of edematous...

Fig. 6: Non-enhanced CT scan (A) performed during the 2nd week of disease shows a fluid...

Learning objectives

Review acute pancreatitis imaging features, focusing on the differentiation between interstitial oedematous pancreatitis and necrotizing pancreatitis, and between the various pancreatic and peripancreatic fluid collections. Review the regional complications.

Background

Acute pancreatitis (AP) is an inflammatory process of the pancreas that classically presents with abdominal pain and elevated serum pancreatic enzymes. It is a common cause of hospital admission with an annual incidence of 13-45 cases per 100000 persons [1]. Most cases are mild and resolve within the first week with adequate treatment. However, some patients progress to organ failure and/or local complications, in which cases the mortality can range to 30% [1]. Imaging plays an important role in the management of patients with AP,...

Findings and procedure details

Diagnosis The diagnosis of acute pancreatitis relies on the presence of two or more of the following criteria: typical abdominal pain, elevated serum lipase (three or more times the upper limit of normal) and characteristic imaging findings. More often, imaging is not necessary to establish the diagnosis. When needed, usually in patients with prolonged symptoms and non-diagnostic serum lipase levels or in the sedated patient, contrast-enhanced computed tomography (CECT) is the preferred imaging method. Other indications to perform CECT early in the course of the...

Conclusion

The Revised Atlanta Classification established a common nomenclature regarding AP. Distinction are made between interstitial oedematous and necrotizing pancreatitis and among the various fluid collections seen. Familiarity with this classification and with its imaging counterparts is of greatest importance to convey accurate information to the referring clinicians and thus assist in the management of the patient.

Personal information

References

W. Group, I.A.P. Apa, A. Pancreatitis, IAP/APA evidence-based guidelines for the management of acute pancreatitis, Pancreatology. 13 (2013) e1-15. doi:10.1016/j.pan.2013.07.063. E.L. Bradley, A Clinically Based Classification System for Acute Pancreatitis: Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 Through 13, 1992, Arch. Surg. 128 (1993) 586–590. doi:10.1001/archsurg.1993.01420170122019. P.A. Banks, T.L. Bollen, C. Dervenis, H.G. Gooszen, C.D. Johnson, M.G. Sarr, G.G. Tsiotos, S.S. Vege, Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus, Gut. 62 (2013) 102–111....