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Radiology Image: A 42-year-old male

A 42-year-old male

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Patient data
  • Age: 42
  • Gender: Male
  • Medical history: Recurrent upper gastrointestinal bleeding (six times). No current medication.
  • Intoxications: 7-8 EH alcohol per day.
  • Initial presentation: Acute pain upper abdomen.
  • Examination: Pressure pain upper abdomen, active muscular resistance.

CT-abdomen

CT-abdomen

CT-abdomen

Question about the CT-abdomen.

S. Spijkers & M. Maas

Checklist CT (Abdomen)

  • Abdominal wall:
    • (Especially periumbilical and inguinal regions) hernias, enlarged lymph nodes?
  • Liver and spleen:
    • Homogeneous parenchyma without focal lesions?
    • Well-defined surfaces?
  • Gallbladder:
    • Well-defined, thin wall?
    • Calculi?
  • Pancreas, adrenals:
    • Well-defined, size normal?
    • Any intraperitoneal/retroperitoneal fat?
  • Kidneys, ureter and bladder:
    • Symmetric excretion of CM?
    • Obstruction, atrophy, bladder wall smooth and thin?
  • Reproductive organs:
    • Uniform prostate of normal size?
    • Spermatic cord, uterus, ovaries?
  • GIT:
    • Well-defined?
    • Normal thickness of walls?
    • Stenoses or dilations?
  • Retroperitoneum:
    • Vessels: aneurysms? thromboses?
    • Enlarged lymph nodes?
  • Bone window:
    • Lumbar spine and pelvis: degenerative lesions? Fractures?
    • Focal sclerotic or lytic lesions?
    • Spinal stenoses?
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In acute pancreatitis contrast-enhanced CT is the imaging modality of choice if the diagnosis is unclear and/or to assess disease severity and complications. Below the CT findings which can be seen in acute pancreatitis.

CT findings acute pancreatitis – Abnormalities that may be seen in the pancreas include:

    • Focal or diffuse parenchymal enlargement
    • Changes in density because of edema
    • Indistinct pancreatic margins owing to inflammation
    • Surrounding retroperitoneal fat stranding
  • Liquefactive necrosis of pancreatic parenchyma
    • Lack of parenchymal enhancement
    • Often multifocal
  • Infected necrosis
    • Difficult to distinguish from aseptic liquefactive necrosis
    • Presence of gas is helpful
    • FNA helpful
  • Abscess formation
    • Circumscribed fluid collection
    • Little or no necrotic tissues (thus distinguishing it from infected necrosis)
  • Haemorrhage
    • High-attenuation fluid in the retroperitoneum or peripancreatic tissues

CT acute pancreatitis

  1. Radiologyassistant.nl. The Radiology Assistant : Pancreas – Acute Pancreatitis 2.0 [Internet]. 2015 [cited 1 July 2015]. Available here 
  2. Hofer M. CT teaching manual – A systematic approach to CT reading. Stuttgart: Thieme; 2007.Available here

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