EURORAD ESR

Case 13676

Necrotizing pancreatitis: peripancreatic necrosis alone

Author(s)
Delgado-Moraleda JJ, Brugger-Frigols S, Flores-Méndez JA, Piqueras-Olmeda RM, Ochoa-Santiago YM, Albertz-Arévalo N.

Hospital La Fe,
Valencia, Spain;
Email:juandelgadomoraleda@gmail.com
 
Patient
female, 62 year(s)
 
 
  • Figure 1
    First CT, arterial phase. Transversal (1).

    Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space, with upper extension to subphrenic space.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 2
    First CT, arterial phase. Transversal (2).

    Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 3
    First CT, arterial phase. Coronal.

    Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left...

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 4
    First CT, arterial phase. Sagittal.

    Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left...

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 5
    First CT, venous phase. Transversal (1).

    Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space, with upper extension to subphrenic space.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 6
    First CT, venous phase. Transversal (2).

    Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 7
    First CT, venous phase. Coronal.

    Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left...

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Abscess; Inflammation;
     
     
  • Figure 8
    First CT, venous phase. Sagittal.

    Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left...

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 9
    Second CT, venous phase. Transversal (1).

    CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 10
    Second CT, venous phase. Transversal (2).

    CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 11
    Second CT, venous phase. Coronal.

    CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 12
    Second CT, venous phase. Sagittal.

    CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
  • Figure 13
    Second CT. Drainage tubes.

    For treatment, there have been placed three drainage tubes. One of them is placed in the left anterior pararenal space. The other two are placed in left paracolic gutter.

     
    Area of Interest: Abdomen; Gastrointestinal tract; Pancreas; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Special Focus: Acute; Inflammation;
     
     
Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space, with upper extension to subphrenic space.
 
Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space, with upper extension to subphrenic space.
 
Acute necrotic collections (ANCs), affecting retroperitoneal spaces: left anterior pararenal space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
Acute necrotic collections (ANCs) on left anterior pararenal space, with upper extension to subphrenic space and lower extension until iliac fossa, affecting left paracolic gutter, posterior pararenal space and left psoas muscle.
 
CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).
 
CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).
 
CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).
 
CT is repeated four weeks later. The walls of these collections show an enhancing wall after intravenous contrast administration, which is indicative of walled-off necrosis (WON).
 
For treatment, there have been placed three drainage tubes. One of them is placed in the left anterior pararenal space. The other two are placed in left paracolic gutter.
 
 
 
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