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Pancreatitis
Alexander J. Towbin, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Acute pancreatitis (AP): Acute inflammation of pancreas with variable involvement of local/regional tissues
            • 2 of 3 features are required for diagnosis
              • Abdominal pain consistent with disease
              • Rise in serum amylase or lipase ≥ 3x normal
              • Imaging findings consistent with AP
            • 2 types of AP
              • Interstitial edematous pancreatitis
              • Necrotizing pancreatitis
          • Acute recurrent pancreatitis (ARP): ≥ 2 distinct episodes of AP with complete resolution of pain for ≥ 1 month or normalization of enzyme levels
          • Chronic pancreatitis (CP): Requires 1 or more of following clinical features or imaging findings of chronic pancreas damage
            • Abdominal pain consistent with pancreatic origin
            • Exocrine pancreatic insufficiency
            • Endocrine pancreatic insufficiency
          • Fluid collections
            • Acute peripancreatic fluid collection: Fluid collection associated with interstitial edematous pancreatitis during first 4 weeks
            • Pancreatic pseudocyst: Fluid collection associated with interstitial edematous pancreatitis after first 4 weeks
            • Acute necrotic collection: Collection containing fluid & necrotic material during first 4 weeks
            • Walled-off necrosis: Collection containing fluid & necrotic material after first 4 weeks

        IMAGING

        • General Features

          • Radiographic Findings

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Nonvascular Interventions

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Murati MA et al: Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification. Pediatr Radiol. ePub, 2021
                                      2. Trout AT et al: NASPGHAN and the Society for Pediatric Radiology joint position paper on noninvasive imaging of pediatric pancreatitis: literature summary and recommendations. J Pediatr Gastroenterol Nutr. 72(1):151-67, 2021
                                      3. Trout AT et al: Noninvasive imaging of pediatric pancreatitis: joint recommendations from the NASPGHAN and the Society for Pediatric Radiology. Pediatr Radiol. 51(1):8-10, 2021
                                      4. Trout AT et al: Current state of imaging of pediatric pancreatitis: AJR expert panel narrative review. AJR Am J Roentgenol. 217(2):265-77, 2021
                                      5. Grover AS et al: Updates in pediatric pancreatology: proceedings of the NASPGHAN Frontiers in Pediatric Pancreatology Symposium. J Pediatr Gastroenterol Nutr. 68(2):e27-33, 2019
                                      6. King G et al: Autoimmune pancreatitis in a child: a challenging diagnosis. Arch Dis Child.106(2):185, 2019
                                      7. Abu-El-Haija M et al: Pediatric chronic pancreatitis: Updates in the 21st century. Pancreatology. 18(4):354-59, 2018
                                      8. Trout AT et al: Normal pancreatic parenchymal thickness by CT in healthy children. Pediatr Radiol. 48(11):1600-5, 2018
                                      9. Abu-El-Haija M et al: Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr. 64(6):984-90, 2017
                                      10. Trout AT et al: Secretin-enhanced magnetic resonance cholangiopancreatography for assessing pancreatic secretory function in children. J Pediatr. 188:186-91, 2017
                                      11. Restrepo R et al: Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol. 206(3):632-44, 2016
                                      12. Pohl JF et al: Paediatric pancreatitis. Curr Opin Gastroenterol. 31(5):380-6, 2015
                                      13. Zhao K et al: Acute pancreatitis: revised Atlanta classification and the role of cross-sectional imaging. AJR Am J Roentgenol. 205(1):W32-41, 2015
                                      14. Thoeni RF: The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 262(3):751-64, 2012
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Acute pancreatitis (AP): Acute inflammation of pancreas with variable involvement of local/regional tissues
                                                • 2 of 3 features are required for diagnosis
                                                  • Abdominal pain consistent with disease
                                                  • Rise in serum amylase or lipase ≥ 3x normal
                                                  • Imaging findings consistent with AP
                                                • 2 types of AP
                                                  • Interstitial edematous pancreatitis
                                                  • Necrotizing pancreatitis
                                              • Acute recurrent pancreatitis (ARP): ≥ 2 distinct episodes of AP with complete resolution of pain for ≥ 1 month or normalization of enzyme levels
                                              • Chronic pancreatitis (CP): Requires 1 or more of following clinical features or imaging findings of chronic pancreas damage
                                                • Abdominal pain consistent with pancreatic origin
                                                • Exocrine pancreatic insufficiency
                                                • Endocrine pancreatic insufficiency
                                              • Fluid collections
                                                • Acute peripancreatic fluid collection: Fluid collection associated with interstitial edematous pancreatitis during first 4 weeks
                                                • Pancreatic pseudocyst: Fluid collection associated with interstitial edematous pancreatitis after first 4 weeks
                                                • Acute necrotic collection: Collection containing fluid & necrotic material during first 4 weeks
                                                • Walled-off necrosis: Collection containing fluid & necrotic material after first 4 weeks

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • Ultrasonographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Nonvascular Interventions

                                                        • Imaging Recommendations

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Staging, Grading, & Classification

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Murati MA et al: Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification. Pediatr Radiol. ePub, 2021
                                                                          2. Trout AT et al: NASPGHAN and the Society for Pediatric Radiology joint position paper on noninvasive imaging of pediatric pancreatitis: literature summary and recommendations. J Pediatr Gastroenterol Nutr. 72(1):151-67, 2021
                                                                          3. Trout AT et al: Noninvasive imaging of pediatric pancreatitis: joint recommendations from the NASPGHAN and the Society for Pediatric Radiology. Pediatr Radiol. 51(1):8-10, 2021
                                                                          4. Trout AT et al: Current state of imaging of pediatric pancreatitis: AJR expert panel narrative review. AJR Am J Roentgenol. 217(2):265-77, 2021
                                                                          5. Grover AS et al: Updates in pediatric pancreatology: proceedings of the NASPGHAN Frontiers in Pediatric Pancreatology Symposium. J Pediatr Gastroenterol Nutr. 68(2):e27-33, 2019
                                                                          6. King G et al: Autoimmune pancreatitis in a child: a challenging diagnosis. Arch Dis Child.106(2):185, 2019
                                                                          7. Abu-El-Haija M et al: Pediatric chronic pancreatitis: Updates in the 21st century. Pancreatology. 18(4):354-59, 2018
                                                                          8. Trout AT et al: Normal pancreatic parenchymal thickness by CT in healthy children. Pediatr Radiol. 48(11):1600-5, 2018
                                                                          9. Abu-El-Haija M et al: Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr. 64(6):984-90, 2017
                                                                          10. Trout AT et al: Secretin-enhanced magnetic resonance cholangiopancreatography for assessing pancreatic secretory function in children. J Pediatr. 188:186-91, 2017
                                                                          11. Restrepo R et al: Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol. 206(3):632-44, 2016
                                                                          12. Pohl JF et al: Paediatric pancreatitis. Curr Opin Gastroenterol. 31(5):380-6, 2015
                                                                          13. Zhao K et al: Acute pancreatitis: revised Atlanta classification and the role of cross-sectional imaging. AJR Am J Roentgenol. 205(1):W32-41, 2015
                                                                          14. Thoeni RF: The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 262(3):751-64, 2012