Necrotizing pancreatitis complicated by hemorrhage

Case contributed by Dr Michael P Hartung

Presentation

Epigastric pain.

Patient Data

Age: 45 years
Gender: Male
CT

Day 1 - Presentation

Hypoenhancement of ~30% of the pancreatic parenchyma involving the head, neck, proximal body. 

Acute necrotic collections about the pancreas and extending into the retroperitoneum. Small amount of ascites. 

Partially occlusive thrombus in the proximal portal and splenic veins. 

Hemorrhage involving necrotic areas of the pancreatic neck and proximal body, evidenced by T1 hyperintensity. Small amount of hemorrhage about the tail. 

Dynamic post-contrast images degraded by motion and not included. 

Similar appearance of acute necrotic collections on T2W images. 

Case Discussion

Key teaching points:

  1. Hypoenhancing (necrotic) areas of the pancreas are increasingly conspicuous on narrow (liver) windows
  2. When there is necrotizing pancreatitis, the collections about the pancreas are referred to as "acute necrotic collections" until around week 4 when they are organized, and then are referred to as "walled-off necrosis"
  3. Necrotizing areas can be complicated by hemorrhage, and is evidenced by increasing complex appearance on CT or T1W hyperintensity on MRI.
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Case information

rID: 67197
Published: 24th Mar 2019
Last edited: 25th Mar 2019
Inclusion in quiz mode: Included

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