Type:
Educational Exhibit
Keywords:
Abdomen, Pancreas, CT, Diagnostic procedure, Contrast agent-intravenous, Education and training, Pathology, Abscess
Authors:
T. D. Melo1, A. T. Almeida2, F. Calejo Pires3; 1Gondomar/PT, 2Vila Nova de Gaia/PT, 3Porto/PT
DOI:
10.26044/ecr2019/C-2498
Background
Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas with variable involvement of local tissues and distant organs.
Clinically it can manifest as a transient local abdominal discomfort or it may present with irreversible systemic complications and,
eventually,
death.
Gallstones and alcohol are the most common causes of AP.
Obesity and older age are known risk factors for AP.
The incidence of AP is increasing worldwide,
probably due to the rising incidence of gallstones and obesity.
Acute pancreatitis diagnosis requires two of three features:
- Abdominal pain suggestive of AP (epigastric pain radiating to the back);
- A threefold increase in serum amylase or lipase levels;
- Characteristic imaging findings.
AP is mainly a clinical diagnosis,
and many patients will meet the criteria for the diagnosis on the basis of symptoms and laboratory results alone.
Therefore,
not all patients with acute pancreatitis need to undergo contrast-enhanced computed tomography (CECT).
Imaging should be reserved for:
- When the clinical diagnosis is in doubt (typical abdominal pain with normal laboratory data);
- Patients who fail to clinically improve within the first 48–72 hours;
- Evaluate suspected complications;
- Elucidating the underlying cause of disease.
Revised Atlanta classification (AC) is a standardized clinical and radiological nomenclature,
created to facilitate objective communication between medical teams.
This classification focuses heavily on morphologic pancreatic and peripancreatic abnormalities for defining the various manifestations of acute pancreatitis and guide treatment options.
According to Atlanta classification CECT is the primary imaging tool for morphologic evaluation of AP.
Computed tomography (CT) should be ideally performed 72 hours from onset of symptoms for a correct assessment of complications,
and repeated when the clinical picture drastically changes.
Disease severity is stratified by organ failure,
local and systemic complications.
A majority of patients have mild acute pancreatitis,
which lacks organ failure and local or systemic complications.
However,
approximately 15% to 20% of AP patients will have a complicated clinical course with organ failure and/or local complications.
Local complications include necrosis of the pancreas and/or the peripancreatic tissues,
pancreatic and/or peripancreatic collections,
and vascular complications.