Acute Pancreatitis

M Stephen Ledbetter, MD
Donald DiSalvo, MD

July 24, 1996

Presentation

A 38-year-old woman presented with severe epigastric pain (radiating to her back), diarrhea, and foul smelling, yellow stools. Serum amylase and lipase were elevated.

Imaging Findings

Abdominal ultrasonography

Sonographic images show pancreatic head enlargement at 5.4 cm (arrow), splenic vein edema along the body of the pancreas (arrow), and retroperitoneal fluid within the anterior pararenal space (arrow). Normal flow was detected in the splenic vein with color doppler and echogenicity of the pancreas was normal.

Differential Diagnosis

Pancreatic neoplasm
Lymphoma
Splenic vein thrombosis
Posterior duodenal ulcer
Pancreatitis

Diagnosis

Acute pancreatitis

Discussion

The normal pancreas measures approximately 3 cm at the head, 2 cm at the body, and 1 cm at the tail. In acute pancreatitis, the gland may be enlarged and have decreased echogenicity secondary to edema. In most cases of acute pancreatitis, however, the ultrasound examination is entirely normal. Splenic vein edema has been described as a secondary finding of acute pancreatitis. In chronic pancreatitis, the pancreas is decreased in size secondary to fibrosis, and the echogenicity is increased owing to fatty infiltration. Dystrophic calcifications and ductal dilatation are also hallmarks of chronic pancreatitis.

References

1. Jeffrey RB, Laing FC, Wing, VW. Extrapancreatic spread of acute pancreatitis: New observations with real-time US. Radiology 1986; 159: 707-711.

2. Krebs CA, Giyanani, VL, Eisenberg RL. Ultrasound atlas of disease processes. Norwalk, CT: Appleton & Lange, 1993: 88-89.

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