Type:
Educational Exhibit
Keywords:
Abdomen, Pancreas, Oncology, CT, Diagnostic procedure, Image compression, Acute, Inflammation, Neoplasia
Authors:
M. J. Regaña Feijoó, T. Díaz Antonio, L. Dominguez Gomez, A. Ruiz Salas, A. Dominguez Igual, C. Leiva Vera; Malaga/ES
DOI:
10.1594/ecr2018/C-0737
Findings and procedure details
In the imaging diagnosis, ultrasound currently has a limited role in the detection of cholelithiasis (etiological diagnosis),
with MRI presenting a similar sensibility but less accessibility.
In most acute pancreatitis,
with a self-limited course,
no further diagnostic tests will be necessary.
In the case of severe acute pancreatitis,
in which the management of patients will depend directly on the local and distant complications,
the modality of choice is CT with intravenous contrast.
It is important to recognize the radiological manifestations associated with the phenomenon of fatty saponification,
which usually appear after the resolution of ascites and exudate in the context of acute pancreatitis.
The most characteristic feature is the presence of multiple nodular lesions of small size and dispersed at the mesenteric or retroperitoneal level,
which may have a mass effect and delayed enhancement after administration of intravenous contrast,
due to the slow dilution of the same through the capillaries of the granulation tissue.
On rare occasions they converge and can form real masses.
These findings simulate peritoneal carcinomatosis,
both entities being radiologically indistinguishable.
The clinical context and the evolution over time will be decisive in their differentiation,
although there are cases of long evolution that pose serious diagnostic doubts and for whose characterization an anatomopathological sample will be necessary.
It is important that the radiologist knows and considers this entity before anticipating to give a false diagnosis of peritoneal carcinomatosis,
thus avoiding anxiety to the patient and the performance of other complementary tests and / or unnecessary invasive techniques.
We will analyze several cases of post-pancreatitis saponification phenomenon presented in our center; in one of them,
the diagnosis of pancreatitis was made as a result of this finding.
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