Image Based Question-71145

A 68-year-old patient, a chronic drinker, complained of severe epigastric pain for one day. The pain was of sudden onset, radiating to the back and associated with repeated vomiting. Physical examination showed local tenderness and guarding over the epigastrium.

Blood tests revealed markedly elevated serum amylase, liver function test was normal and white cell count was not elevated. A CECT abdomen was performed for further assessment.What can be the most possible diagnosis?

A. Acute Pancreatitis

B. Chronic Pancreatitis

C. Pancreatic Carcinoma

D. Pancreatic Stone

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Correct Answer » A Explanation

Ans:A. Acute Pancreatitis.

Image shows: Contrast enhanced axial computed tomography shows a markedly swollen and low density(oedematous) pancreatic head with ill-defined margins(arrows) in a patient with acute pancreatitis. Note the dilated pancreatic duct (arrowheads).

ACUTE PANCREATITIS

• This signifies an acute inflammation of the pancreas and may be caused by gallstones, alcoholism, infection, trauma, drugs, etc.

The pancreatic pathology is well demonstrated by CT and findings include:

1. Swollen and oedematous (decreased density) pancreas with ill-defined margins (signify the presence of acute inflammation within pancreatic tissue)
2. Peripancreatic fluid collection/ abscess formation .
3. Pseudo-cyst formation- ‘pseudo’ meaning that this collection of fluid is not lined by epithelium (which is seen in a true cyst). This usually forms 6-8 weeks after the acute episode
4. Lack of normal parenchymal enhancement within the pancreas after intravenous contrast administration

Indicates pancreatic necrosis in cases of necrotizing pancreatitis

1. ilatation of adjacent bowel loops- So-called ‘sentinel loop’ sign which indicates local paralytic ileus in response to adjacent inflammation
2. Changes of oedema/inflammation in soft tissue around the pancreas, kidney.

Chest radiographic changes in acute pancreatitis include:

1. Left sided pleural effusion with elevated amylase levels
2. Elevation of the left hemidiaphragm and left lower lobe atelectasis
3. Pericardial effusion
4. Fistula formation between pancreas and pleura or bronchus