Presentation
Diabetic patient had a history of acute epigastric pain and elevated amylase levels about 5 weeks ago.
Patient Data
Swollen pancreas with non enhancing parenchyma (sparing the pancreatic tail) in keeping with "necrotizing pancreatitis", the pancreas is surrounded by large capsulated peripancreatic fluid collection which is abutting the stomach anteriorly. Smudging and fluid edema are seen at the peripancreatic fat planes.
Loss of signal void & post contrast enhancement of the splenic vein (likely thrombosed)
Case Discussion
Features of necrotizing pancreatitis with surrounding organizing collection "walled-off pancreatic collection" and stranding, along with thrombosed splenic vein.
The following are the latest terms according to the updated Atlanta classification to describe fluid collections associated with acute pancreatitis:
- fluid collections associated with interstitial edematous pancreatitis (i.e. minimal or no necrosis)
- acute peripancreatic fluid collections (APFC): in the first 4 weeks: non-encapsulated peripancreatic fluid collections
- pseudocysts: develop after 4 weeks; encapsulated peripancreatic or remote fluid collections
- fluid collections associated with necrotizing pancreatitis
- acute necrotic collections (ANCs): in the first 4 weeks; non-encapsulated heterogeneous non-liquefied material
- walled-off necrosis (WON or WOPN): develop after 4 weeks; encapsulated heterogeneous non-liquefied material