GI Radiography


Case 7 :
 

Click here for Bigger Picture

Click here for Bigger Picture


A 33-year-old male with acute pain in abdomen. A CT scan abdomen was requested. 
What is the diagnosis?

__________SCROLL FOR ANSWER__________

 






 

Imaging Findings

Study shows large pockets of air within and around parenchyma of pancreas. Peri-pancreatic fat planes are lost. Collection is seen anterior to the body of pancreas and in the lesser sac.

Diagnosis

Acute emphysematous pancreatitis (sepsis)

Discussion

Sepsis is a major complication of pancreatitis and is accompanied by a high incidence of mortality and prolonged hospital stay. The sure sign on CT is the presence of gas bubbles within the pancreas or around pancreas, due to secondary infection by coliform bacteria. Gas is easily differentiated from fat, as its HU value is beyond -100, and it is jet-black, compared to fat which is grayish, and has an HU below 100.

Surgical debridement, necrosectomy and drainage via pigtail/ sump catheters are the usual treatment employed for sepsis/ necrosis. The latter have met with limited success.

Contribution

Dr Ashok Raghavan, Manipal Hospital, Bangalore.