Computed tomography of acute pancreatitis

The article is professionally consulted by MSc, BS. Dang Manh Cuong - Radiologist - Radiology Department - Vinmec Central Park International General Hospital. The doctor has over 18 years of experience in the field of ultrasound - diagnostic imaging.

Acute pancreatitis is an acute inflammation of the pancreas that occurs when the pancreas automatically releases enzymes that destroy the pancreas. Acute pancreatitis is classified into 2 types:
Mild acute pancreatitis: also known as acute pancreatitis. In this condition, sometimes only a short hospital stay, few complications occur. Severe acute pancreatitis: bleeding necrosis easily leads to infection, respiratory failure, circulatory reduction, organ dysfunction with a high mortality rate of 20-50%. The most important task is to need imaging for acute pancreatitis to assess the extent of damage, determine the correct disease form and choose the appropriate treatment method.

The main cause of acute pancreatitis is alcohol and gallstones, gallstones.

2.1. Due to alcohol abuse Acute pancreatitis usually occurs in men with an average age of 50-60 years.
2.2. Due to stones It has been found that the relationship between gallstones and acute pancreatitis, if there are 4 small stones < 4mm in the gallbladder, the risk is very high for acute pancreatitis.
2.3. Other causes Due to metabolic disorders: hypertriglyceridemia, hypercalcemia (thyroid tumor, hyperparathyroidism...) After endoscopic retrograde cholangiopancreatography (ERCP). After pancreatic trauma, abdominal bruising, surgery near the pancreas, around the pancreas. Due to infections: mumps, viral hepatitis, roundworms, worms in the common bile duct and pancreatic duct... After organ transplant surgery such as kidney transplant, heart transplant. Due to acute fatty liver in pregnancy. Due to organized diseases such as: necrotizing vasculitis, lupus erythematosus, Schonlein-Henoch vasculitis... Drugs: furosemide, sulfonamide, 6MP, oestrogen, ethanol... Primary or metastatic pancreatic tumor etiology, or other causes of pancreatic duct obstruction.

3.1. Advantages of Pancreatic Tomography Currently, there are many methods to help diagnose acute pancreatitis such as: ultrasound, tomography of the pancreas, magnetic resonance imaging, endoscopy...etc... In which, microscopic tomography Calculation is the most common technique for diagnosing acute pancreatitis, helping in prognosis, monitoring and detecting complications, even supporting treatment with interventional radiology.

The advantages of tomography of the pancreas :
Analysis of the pancreatic and parapancreatic compartments. Assessment of pancreatic parenchymal status. Assess the degree of necrosis in the peritoneal cavity, retroperitoneum, mediastinum, hypogastric... Detecting stones in the biliary tract (Oddi stones). Support the diagnosis of causes of acute pancreatitis such as alcohol, cirrhosis, portal vein pressure, fatty liver, pancreatic calcification... 3.2. Imaging diagnosis of acute pancreatitis If the patient has acute pancreatitis, when scanning the pancreas, the following images will be seen:
Signs in the parenchyma:
Pancreatitis diffusely or regionally. The posterior peritoneum is thickened, the intra-abdominal mesentery is common on the left side. Unknown pancreatic margins represent progressive inflammation. There may be signs of edema surrounding the pancreas. The Wirsung tube may be normal or slightly dilated. Prior to the injection of the hypodense pancreatic contrast agent, there were hyperattenuating patches indicating new bleeding. After injection of the non-isoattenuated pancreatic parenchyma, areas of hypogravity present with edema, focal ischemia, or necrosis. Extra-parenchymal signs:
Mild acute pancreatitis: the fat layer near the pancreas is blurred, the density is increased, the fat wall is erased in the gland, the pancreatic border is not clear. Severe acute pancreatitis: decreased mass density, pancreatic border is not clear. After contrast injection, the inflammation becomes an outbreak, has the density of the fluid, and the border is clear.

In addition, acute pancreatitis is also determined if computed tomography shows the following complications:
Pleural effusion: the rate of ascites accounts for 7%, severe acute pancreatitis will show focal effusion on the left side or both beside. There may be disturbances in ventilation at the bottom of the lungs. Pancreatic pseudocysts: These are pancreatic pseudocysts. Abscess is non-homogeneous, partially absorbed after drug injection, gas is found in the mass. Distal pancreatic necrosis line: see mass syndrome, change in density of fluid, no or little contrast agent. 3.3. Classification of acute pancreatitis To assess the degree of pancreatitis, people use Balthazar's classification method according to the levels:
Garde A: The pancreas is normal. Garde B: Diffuse or focal pancreatitis, or an irregular pancreatic margin. Garde C: Detecting a thin layer of fat around the pancreas. Garde D: There is an outbreak near the pancreas. Garde E: Inside or outside the pancreas, there are 2 outbreaks or gas is seen. Garde A, B usually lead to less complications, in contrast to garde C, D, E have a high risk of complications.

Today, the imaging of acute pancreatitis plays an important role in detecting and determining the treatment method. Pancreatic computed tomography helps confirm the diagnosis, detect complications (if any), help prognosis and select treatment. Other techniques such as endoscopic ultrasound , Doppler ultrasound will be applied when it is necessary to guide aspiration drainage later.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, a system of modern equipment and technology. The hospital provides comprehensive and professional medical examination, consultation and treatment services, with a civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.