Wk 2, Case 2 - Review

PATIENT HISTORY: Abdominal pain

Study: CT abdomen pelvis with intravenous contrast.

Indication: Abdominal pain.

TECHNIQUE: CT images of the abdomen and pelvis were obtained after the administration of intravenous contrast. Oral contrast was administered.

FINDINGS:

Lung bases: There are bilateral pleural effusions, left greater than right with adjacent atelectatic changes. Right pleural catheter is partially imaged.

Hepatobiliary: Liver is unremarkable. Cholelithiasis/sludge is noted in the gallbladder. There is no biliary ductal dilatation.

Pancreas: There are findings compatible with necrotizing pancreatitis, with the pancreatic parenchyma essentially replaced by a large heterogeneous collection. Adjacent peripancreatic fluid collections are also present, with some of this tracking along the retroperitoneal fascial planes. These presumably represent acute necrotic collections or regions of walled off necrosis.

Spleen: Unremarkable.

Adrenal glands: Unremarkable.

Kidneys: Unremarkable.

Bowel: No bowel obstruction. Two enteric tubes are noted, one of which terminates in the stomach while the other terminates just past the ligament of Treitz.

Abdominal and pelvic lymph nodes: No lymphadenopathy.

Peritoneum: Small to moderate amount of free fluid is present.

Vasculature: No abdominal aortic aneurysm. The splenic and superior mesenteric veins are attenuated by the pancreatic/peripancreatic collection though remain patent.

Pelvis: Bladder is collapsed around a Foley catheter with expected intraluminal bladder gas present. A drainage catheter terminates in the pelvis.

Musculoskeletal system and soft tissue: No aggressive osseous lesion. Soft tissue anasarca is present.


IMPRESSION:

Necrotizing pancreatitis as described.