ARRS 2022 Abstracts


E1670. Case-Based Review of Acute and Chronic Pancreatitis and Its Complications
  1. Ruskin Cua; Department of Radiology, Keck School of Medicine
  2. Kevin Junus; Department of Radiology, Keck School of Medicine
  3. Brittany Kazmierski; Department of Radiology, Keck School of Medicine
  4. Miriam Romero; Department of Radiology, Keck School of Medicine
Acute pancreatitis is an inflammatory disorder with increasing prevalence and a reported annual incidence of 4.9 to 35 per 100,000. Acute pancreatitis is one of the most common causes of inpatient gastrointestinal admission in the US. Gallstones are the most frequent etiology of acute and chronic pancreatitis, followed by alcohol abuse. Other important etiologies include metabolic derangement, trauma, and autoimmune pancreatitis. The 2012 Revised Atlanta Classification requires two or more of the following to diagnose acute pancreatitis: typical abdominal pain, serum amylase or lipase elevation greater than three times the upper normal value, and characteristic imaging findings. Although identification of the characteristic imaging findings of pancreatitis on CT (diffuse parenchymal enlargement with edema and surrounding retroperitoneal fat stranding) is generally not difficult, evaluation and classification of the complications of pancreatitis can be less straightforward, particularly with ultrasound and MRI. Furthermore, atypical presentations of pancreatitis such as groove pancreatitis are less widely known.

Educational Goals / Teaching Points
The goals of this exhibit are to review common and uncommon causes of acute and chronic pancreatitis through a series of cases with targeted questions and teaching points; highlight important sequalae of pancreatitis including fluid collections and vascular complications; and illustrate comparative anatomy via a multimodality approach with additional emphasis on MRI and ultrasound.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The pancreas is a retroperitoneal gland divided into four parts: head, neck, body, and tail. The uncinate process is the inferomedial extension of the pancreatic head posterior to the mesenteric vessels. The main pancreatic duct of Wirsung courses from the tail to the head and drains into the major papilla. An accessory duct of Santorini originates from the duct of Wirsung and drains into the minor papilla. Acute pancreatitis can be further classified into interstitial edematous pancreatitis (AIEP) and necrotizing pancreatitis (ANP), with prevalence of approximately 70% and 30% respectively. Complications of acute pancreatitis can be divided based on location: local, remote abdominal, and systemic. Local complications include peripancreatic and parenchymal fluid collections, which can be subdivided based on timing and association with parenchymal necrosis. Remote abdominal complications include vascular complications, such as thrombosis and pseudoaneurysm. Groove pancreatitis and autoimmune pancreatitis are relatively uncommon, but their imaging features are important to recognize.

Familiarity with common and uncommon causes of acute and chronic pancreatitis and subsequent recognition of complications is key to avoid resultant morbidity and mortality. Thorough knowledge and a high degree of suspicion is essential in guiding diagnosis to ensure appropriate clinical management.