Acute pancreatitis CT

Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality^[1] . In addition, CT contrast may exacerbate pancreatitis,^[2] although this is disputed.^[3][4]

Regarding the need for computed tomography, practice guidelines state:

2006: “Many patients with acute pancreatitis do not require a CT scan at admission or at any time during the hospitalization. For example, a CT scan is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a CT scan at admission (but not necessarily a CT with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a perforated ulcer.” ^[5][4]

2005: “Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6–10 days after admission will require CT (recommendation grade B).”^[6]

CT abdomen should not be performed before the 1st 48 hours of onset of symptoms as early CT (<48 h) may result in equivocal or normal findings.

CT findings can be classified into the following categories for easy recall :

• Intrapancreatic – diffuse or segmental enlargement, edema, gas bubbles, pancreatic pseudocysts and phlegmons/abscesses (which present 4 to 6 weeks after initial onset)
• Peripancreatic / extrapancreatic – irregular pancreatic outline, obliterated peripancreatic fat, retroperitoneal edema, fluid in the lesser sac, fluid in the left anterior pararenal space
• Locoregional – Gerota’s fascia sign (thickening of inflamed Gerota’s fascia, which becomes visible), pancreatic ascites, pleural effusion (seen on basal cuts of the pleural cavity), adynamic ileus,

Balthazar Scoring for the grading of acute pancreatitis:

• The CT severity score is the sum of the CT Grade and Necrosis Grade Scores.

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