Case of the Week: Necrotizing Pancreatitis (CT & MRI)

In this radiology lecture, we discuss the imaging appearance of necrotizing pancreatitis on CT and MRI.
Key points include:
1) According to the revised Atlanta classification, there are two types of acute pancreatitis: Interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis (NP).
2) For IEP, fluid collection in first 4 weeks = acute peripancreatic fluid collection, after 4 weeks = pseudocyst.
3) For NP, fluid collection in first 4 weeks = acute necrotic collection, after 4 weeks = walled-off necrosis.
4) Non-enhancing hypoattenuating areas = necrotizing pancreatitis.
5) Gas suspicious for infection/emphysematous pancreatitis.
6) Vascular complications are important to identify.
7) Venous thrombosis: splenic, portal, and mesenteric veins.
8) Pseudoaneurysms: Splenic and gastroduodenal artery.
Click the Community tab or follow on social media for bonus teaching material posted throughout the week!
Website: www.radiologistHQ.com
Video Podcast: bit.ly/radiologistHQ
Instagram: / radiologisthq
Facebook: / radiologistheadquarters
Twitter: / radiologisthq

[@faicalhaouari4489]

Thank you very much doctor , what you do is very helpful for us , keep up on posting !!!

[@Radquarters]

That's great to hear, and I'll keep posting weekly!

[@caiyu538]

Great series. Thank for your kindness to share your excellent tutorials.

[@Radquarters]

My pleasure, and glad you like them!

[@user-wm6hf2nw2j]

Thank you for very helpful video

[@Radquarters]

You’re very welcome, and thank you for watching!

[@suomynonaanonymous]

Great case

[@Radquarters]

Thanks!

[@immane75]

🙏 merci.

[@Radquarters]

You're welcome!

[@caiyu538]

Thumb up and know some cases in abdominal radiology.

[@afrahhammod3821]

👏👏👏

[@Radquarters]

Thank you!

[@Elyrion4409]

Thanks for the great video! I know this is a less common case, but how do you tell the difference between an acute necrotizing pancreatitis that is only affecting the peri-pancreas vs acute peri-pancreatic fluid collection?

[@Radquarters]

Good question! It can sometimes be difficult to differentiate, but pancreatic fluid collections tend to be homogeneous with fluid density. Peripancreatic necrosis tends to be complex and heterogeneous in appearance with areas of fluid denisty and nonliquefied components.

[@rajputi_poshak300]

​@@Radquarters after that treatment it is normal?

[@evkamartuliakova2833]

Sir, please, if we have four weeks after the onset of necrotizing pancreatitis, but ANC are not fully walled off, should we call it WON? Because, in fact, when we report it as WON, it should be really walled-off, and that is not always the case. I'm confused with that...thank you and you are doing great work, I hope there will be more videos :)

[@Radquarters]

If it’s not fully walled off and seems ill-defined, not a true collection, I might just refer to it as just peripancreatic fluid. Another clue for WON is that it often has layering debris within it, although not always the case. I’ll keep up the videos, and thanks for the kind feedback!

[@ChiranjitDebnath0]

Hi sir

[@immane75]

What is the cause for renal infarct ? Thanks

[@Radquarters]

Good question immane75! In this case it was unclear; the renal arteries were patent. I suspect that it may have been due to transient thromboembolic disease.

[@nopenever3]

What were the symptoms?

[@Radquarters]

Abdominal pain and symptoms of pancreatitis.

[@Aprilboy28]

Is its curable or not pls help I'm suffering from this

[@rajputi_poshak300]

Now r u fine from this disease

[@vivekgupta8507]

Kya ab aap thik hai

[@NNCCCC63]

Please speak a little slower

[@Radquarters]

Thank you for the feedback. You can also manually adjust the video speed by clicking the Settings gear icon on the lower right hand corner of the video, and then select Playback speed to slow the video down.