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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 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: ≥ 2 distinct episodes of AP with complete resolution of pain for ≥ 1 month or normalization of enzyme levels
          • Chronic pancreatitis (CP): Relapsing or continuing inflammatory disease of pancreas leading to irreversible destruction of pancreatic parenchyma & ducts with loss of exocrine function
          • 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

            • CT Findings

              • MR Findings

                • Ultrasonographic 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. 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
                                      2. Meyer A et al: Contrasts and comparisons between childhood and adult onset acute pancreatitis. Pancreatology. 13(4):429-35, 2013
                                      3. Srinath AI et al: Pediatric pancreatitis. Pediatr Rev. 34(2):79-90, 2013
                                      4. Thai TC et al: MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population. AJR Am J Roentgenol. 201(6):W877-92, 2013
                                      5. 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 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: ≥ 2 distinct episodes of AP with complete resolution of pain for ≥ 1 month or normalization of enzyme levels
                                              • Chronic pancreatitis (CP): Relapsing or continuing inflammatory disease of pancreas leading to irreversible destruction of pancreatic parenchyma & ducts with loss of exocrine function
                                              • 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

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic 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. 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
                                                                          2. Meyer A et al: Contrasts and comparisons between childhood and adult onset acute pancreatitis. Pancreatology. 13(4):429-35, 2013
                                                                          3. Srinath AI et al: Pediatric pancreatitis. Pediatr Rev. 34(2):79-90, 2013
                                                                          4. Thai TC et al: MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population. AJR Am J Roentgenol. 201(6):W877-92, 2013
                                                                          5. 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