Acute pancreatitis CT: Difference between revisions

Jump to navigation Jump to search
 
(6 intermediate revisions by one other user not shown)
Line 28: Line 28:
==CT==
==CT==
Regarding the need for [[computed tomography]], practice guidelines state:
Regarding the need for [[computed tomography]], practice guidelines state:
: 2006: "Many patients with acute pancreatitis do not require a CT scan at admission or at any time during the hospitalization. For example, a CT scan is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a CT scan at admission (but not necessarily a CT with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a perforated ulcer." <ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref><ref name="acutepancreatitis">{{cite journal
: 2006: "Many patients with acute pancreatitis do not require a [[CT scan]] at admission or at any time during the [[hospitalization]]. For example, a [[CT scan]] is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a [[CT scan]] at admission (but not necessarily a [[CT]] with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a [[perforated ulcer]]." <ref name="pmid17032204">{{cite journal |author=Banks P, Freeman M |title=Practice guidelines in acute pancreatitis |journal=Am J Gastroenterol |volume=101 |issue=10 |pages=2379-400 |year=2006 |id=PMID 17032204 | doi=10.1111/j.1572-0241.2006.00856.x}}</ref><ref name="acutepancreatitis">{{cite journal
| last      = Forsmark
| last      = Forsmark
| first      = Chris E.
| first      = Chris E.
Line 49: Line 49:
}}</ref>
}}</ref>


: 2005: "Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6–10 days after admission will require CT (recommendation grade B)."<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref>
: 2005: "Patients with persisting organ failure, signs of [[sepsis]], or deterioration in clinical status 6–10 days after admission will require [[CT]] (recommendation grade B)."<ref name="pmid15831893">{{cite journal |author=UK Working Party on Acute Pancreatitis |title=UK guidelines for the management of acute pancreatitis |journal=Gut |volume=54 Suppl 3 |issue= |pages=iii1-9 |year=2005 |id=PMID 15831893 | doi=10.1136/gut.2004.057026 | url=http://gut.bmj.com/cgi/content/full/54/suppl_3/iii1}}</ref>


CT abdomen should not be performed before the 1st 48 hours of onset of symptoms as early CT (<48 h) may result in equivocal or normal findings.
CT abdomen should not be performed before the 1st 48 hours of onset of symptoms as early [[CT]] (<48 h) may result in equivocal or normal findings.


CT Findings can be classified into the following categories for easy recall :
CT findings can be classified into the following categories for easy recall :
*Intrapancreatic - diffuse or segmental enlargement, edema, gas bubbles, pancreatic pseudocysts and phlegmons/abscesses (which present 4 to 6 wks after initial onset)
*Intrapancreatic - diffuse or segmental enlargement, [[edema]], gas bubbles, [[Pancreatic pseudocyst|pancreatic pseudocysts]] and phlegmons/[[abscesses]] (which present 4 to 6 weeks after initial onset)
*Peripancreatic / extrapancreatic - irregular pancreatic outline, obliterated peripancreatic fat, retroperitoneal edema, fluid in the lessar sac, fluid in the left anterior pararenal space
*Peripancreatic / extrapancreatic - irregular pancreatic outline, obliterated peripancreatic fat, [[retroperitoneal]] [[edema]], fluid in the lesser sac, fluid in the left [[anterior]] pararenal space
*Locoregional - Gerota's fascia sign (thickening of inflamed Gerota's fascia, which becomes visible), pancreatic ascites, pleural effusion (seen on basal cuts of the pleural cavity), adynamic ileus,
*Locoregional - [[Gerota's fascia]] sign (thickening of inflamed [[Gerota's fascia]], which becomes visible), pancreatic [[ascites]], [[pleural effusion]] (seen on basal cuts of the [[pleural cavity]]), [[adynamic ileus]],
===Balthazar Scoring===
===Balthazar Scoring===
Balthazar Scoring for the Grading of Acute Pancreatitis
Balthazar Scoring for the grading of acute pancreatitis:
 
* The [[Computed tomography|CT]] severity score is the sum of the CT Grade and Necrosis Grade Scores.
The CT Severity Score is the sum of the CT Grade and Necrosis Grade Scores.
 
CT Grade Score


===== CT Grade Score: =====
{| class="wikitable"
{| class="wikitable"
|-
|-
Line 91: Line 89:
|}
|}


Necrosis score
===== Necrosis score: =====
 
{| class="wikitable"
{| class="wikitable"
|-
|-
Line 110: Line 107:
|}
|}


====Patient #2: Necrotizing Pancreatitis====
[[Image:Acute-pancreatitis-8.jpg|500 px|thumb|center|Case courtesy of Dr Rahmoun Fateh, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/18850">rID: 18850</a>]]
 
[[Image:Acute-pancreatitis.jpg|500 px|thumb|center|Case courtesy of <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/11163">rID: 11163</a>]]
[http://www.radswiki.net Copyleft Images courtesy of RadsWiki]
[[Image:Acute-pancreatitis-14 (1).jpg|500 px|thumb|center|Case courtesy of David Puyó, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22434">rID: 22434</a>]]
 
<gallery>
Image:Necrotizing pancreatitis 001.jpg
Image:Necrotizing pancreatitis 002.jpg
Image:Necrotizing pancreatitis 003.jpg
</gallery>


==References==
==References==

Latest revision as of 18:59, 21 December 2017

Acute pancreatitis Microchapters

Home

American College of Gastroenterology Guidelines

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Approach to Therapy

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute pancreatitis CT On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute pancreatitis CT

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute pancreatitis CT

CDC on Acute pancreatitis CT

Acute pancreatitis CT in the news

Blogs on Acute pancreatitis CT

Directions to Hospitals Treating Acute pancreatitis

Risk calculators and risk factors for Acute pancreatitis CT

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[1] . In addition, CT contrast may exacerbate pancreatitis,[2] although this is disputed.[3][4]

CT

Regarding the need for computed tomography, practice guidelines state:

2006: "Many patients with acute pancreatitis do not require a CT scan at admission or at any time during the hospitalization. For example, a CT scan is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a CT scan at admission (but not necessarily a CT with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a perforated ulcer." [5][4]
2005: "Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6–10 days after admission will require CT (recommendation grade B)."[6]

CT abdomen should not be performed before the 1st 48 hours of onset of symptoms as early CT (<48 h) may result in equivocal or normal findings.

CT findings can be classified into the following categories for easy recall :

Balthazar Scoring

Balthazar Scoring for the grading of acute pancreatitis:

  • The CT severity score is the sum of the CT Grade and Necrosis Grade Scores.
CT Grade Score:
CT Grade Appearance on CT CT Grade Points
Grade A Normal CT 0 points
Grade B Focal or diffuse enlargement of the pancreas 1 point
Grade C Pancreatic gland abnormalities and peripancreatic inflammation 2 points
Grade D Fluid collection in a single location 3 points
Grade E Two or more fluid collections and / or gas bubbles in or adjacent to pancreas 4 points
Necrosis score:
Necrosis Percentage Points
No necrosis 0 points
0 to 30% necrosis 2 points
30 to 50% necrosis 4 points
Over 50% necrosis 6 points
Case courtesy of Dr Rahmoun Fateh, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/18850">rID: 18850</a>
Case courtesy of <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/11163">rID: 11163</a>
Case courtesy of David Puyó, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/22434">rID: 22434</a>

References

  1. Fleszler F, Friedenberg F, Krevsky B, Friedel D, Braitman L (2003). "Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis". Am J Med Sci. 325 (5): 251–5. PMID 12792243.
  2. McMenamin D, Gates L (1996). "A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis". Am J Gastroenterol. 91 (7): 1384–7. PMID 8678000.
  3. Hwang T, Chang K, Ho Y (2000). "Contrast-enhanced dynamic computed tomography does not aggravate the clinical severity of patients with severe acute pancreatitis: reevaluation of the effect of intravenous contrast medium on the severity of acute pancreatitis". Arch Surg. 135 (3): 287–90. PMID 10722029.
  4. 4.0 4.1 Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  5. Banks P, Freeman M (2006). "Practice guidelines in acute pancreatitis". Am J Gastroenterol. 101 (10): 2379–400. doi:10.1111/j.1572-0241.2006.00856.x. PMID 17032204.
  6. UK Working Party on Acute Pancreatitis (2005). "UK guidelines for the management of acute pancreatitis". Gut. 54 Suppl 3: iii1–9. doi:10.1136/gut.2004.057026. PMID 15831893.

Template:WS Template:WH