CASE 1328 Published on 10.11.2001
0

Acute pancreatitis without evident cause

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

F. Cademartiri, G. Luccichenti, P. Pavone

Connected authors
Patient

68 years, female

Categories
No Area of Interest ; Imaging Technique CT
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Clinical History
The patient presented with acute upper abdominal pain with fever and leukocytosis. Pain was projecting to the back. Dyspnoea was also present.
Imaging Findings
The patient presented with acute upper abdominal pain with fever and leukocytosis. Pain was projecting to the back. Dyspnoea was also present.

Ultrasound examination demonstrated an enlargement of the pancreatic lodge with fluid in the lateroconal regions. No stones could be visualised in the main extra-hepatic biliary tree. Dilatation of the distal bile duct was seen.

The patient underwent contrast-enhanced thoraco-abdominal CT. A moderate bilateral intra-pleural effusion with mild compressive atelectasis was seen.

Enlargement of the pancreatic lodge with dishomogeneous aspects, intra-abdominal fluid and dilatation of the distal bile duct were seen. No stones were demonstrated. Further studies (intravenous cholangiography) also did not demonstrate any evidence of stones.

The patient did not report a history of alcoholic behaviour.

Discussion
Acute pancreatitis is often secondary to alcoholic behaviour and biliary stones. It can also be a complication of medical procedures, especially ERCP. A small number of cases are without evident cause.

In this case a very small bilirubin stone may have passed through the sphincter of Oddi causing a brief but important obstruction from which acute pancreatitis followed.

It is not always possible to be sure of the diagnosis and further invasive procedures such as ERCP can be very dangerous.

Differential Diagnosis List
Acute necrotising pancreatitis
Final Diagnosis
Acute necrotising pancreatitis
Case information
URL: https://www.eurorad.org/case/1328
DOI: 10.1594/EURORAD/CASE.1328
ISSN: 1563-4086
Figure 1

Aspects of acute necrotising pancreatitis

Aspects of acute necrotising pancreatitis
Axial slice at the level of the coeliac trunk demonstrating the involvement of the structures of the hilum in the flogistic process.
Aspects of acute necrotising pancreatitis
Axial slice at a lower level than the previous one demonstrating the enlarged body of the pancreas with some fluid collected around the pancreatic lodge.
Aspects of acute necrotising pancreatitis
Axial slice at the level of the head of the pancreas demonstrating the enlarged distal bile duct.
Aspects of acute necrotising pancreatitis
Axial slice more caudal than the previous one demonstrating the involvement of the right kidney in the flogistic process.
Aspects of acute necrotising pancreatitis
Axial slice demonstrating the fluid collected in the pleural space and related compressive atelectasis.