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MDCT of Acute Mild (Nonnecrotizing) Pancreatitis: Abdominal Complications and Fate of Fluid Collections

Dipti K. Lenhart1 and Emil J. Balthazar

1 Both authors: Department of Radiology, NYU School of Medicine–Bellevue Hospital Center, 462 First Ave., NB 3W33A, New York, NY 10016.


Figure 1
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  		Fig. 1 —Development of complications in patients with and without peripancreatic fluid collections on initial CT examination.

 

Figure 2
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  		Fig. 2A —Grade E pancreatitis without necrosis in 24-year-old man. Axial image from initial contrast-enhanced CT examination at admission shows multiple large peripancreatic fluid collections (arrows). Entire pancreatic gland shows normal enhancement.

 

Figure 3
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  		Fig. 2B —Grade E pancreatitis without necrosis in 24-year-old man. Axial image from last CT examination 27 days after A reveals development of 6 x 10 cm partially loculated fluid collection (arrows) in lesser sac, which may progress to acute pseudocyst if it becomes fully encapsulated. Patient was lost to follow-up.

 

Figure 4
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  		Fig. 3A —Grade D pancreatitis without necrosis in 44-year-old man. Initial contrast-enhanced axial CT image shows small fluid collection (arrows) adjacent to tail of pancreas and in left anterior pararenal space. Entire pancreas including tail (not shown) showed normal enhancement.

 

Figure 5
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  		Fig. 3B —Grade D pancreatitis without necrosis in 44-year-old man. Axial CT image 2 months after A reveals development of 7 x 6 cm acute pseudocyst (arrows) adjacent to tail of pancreas.

 

Figure 6
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  		Fig. 3C —Grade D pancreatitis without necrosis in 44-year-old man. Axial CT image 2 years after A shows 5 x 4 cm pseudocyst (arrows) with calcification in wall (arrowhead), indicating chronic pseudocyst.

 

Figure 7
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  		Fig. 4A —Grade E pancreatitis without necrosis in 47-year-old man. Axial image from contrast-enhanced CT examination performed 5 months after initial episode for abdominal pain and decrease in hematocrit level shows hemorrhagic pseudocyst (white arrows) in wall of duodenum and leakage of blood (arrowheads) into peritoneal cavity. Additionally, small pseudocyst is present in head of pancreas (black arrow).

 

Figure 8
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  		Fig. 4B —Grade E pancreatitis without necrosis in 47-year-old man. Axial CT image 6 days after A shows that hemorrhagic pseudocyst (arrows) has eroded and perforated postbulbar duodenum, with leakage of free air (arrowheads) into abdomen. Patient underwent surgery with unroofing and drainage of pseudocyst and pyloric exclusion. Hemorrhage and pseudocyst resolved on follow-up CT examinations (not shown).

 

Figure 9
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  		Fig. 5A —Retroperitoneal hemorrhage in 25-year-old man with grade E pancreatitis without necrosis. Initial contrast-enhanced axial CT image reveals large retroperitoneal hematoma (arrows).

 

Figure 10
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  		Fig. 5B —Retroperitoneal hemorrhage in 25-year-old man with grade E pancreatitis without necrosis. Follow-up axial CT image 21 days later shows encapsulated, liquefied retroperitoneal hematoma (arrows). Resolution of hematoma was documented on follow-up CT examinations (not shown).

 

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