الموقع الرسمي للدكتور أحمد رفاعي

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Case 3

12/27/2012

4 Comments

 
Picture
 





Findings :
        
Non enhancement of the tail and distal part of the body of pancreas (white arrow), and normal enhancement of the proximal part (yellow arrow) along with mild peripancreatic fluid collection extends to the left Gerota’s fascia. 
·   Multiple gall bladder stones ( green arrow )
 ·     Mild ascites
 Diagnosis :
 Partial necrotizing pancreatitis

 Clue for the diagnosis:
 The most important finding you have to search in suspected cases of acute pancreatitis, is the presence or absence of necrosis , which presents on enhanced CT as non enhancement of a part ( partial necrotizing) or all ( total necrotizing ) of the pancreas . Necrotic pancreatitis changes the prognosis and mortality rate, as partial necrotizing pancreatitis has a mortality rate up to 70% of cases, whereas total necrotizing pancreatitis has a mortality rate of 100% of cases within 10 days (40% by the 2nd day, 75% by the 5th day and 100% by the 10th day).

 Teaching points:
 •     70% of acute pancreatitis is due to gallbladder stones.
•     The diagnosis is usually made on clinical and laboratory findings.
•     An early CT may be misleading concerning the severity of the
pancreatitis, since it can underestimate the presence and amount of necrosis, so
there is no additional value of an early CT (within 72 hours) in patients with
acute pancreatitis.

 •     There are two types of acute pancreatitis :
 -         Mild acute pancreatitis ----- 80 % , which is further subdivided
into either edematous ( just swelling of the pancreas ), or exudative ( peripancreatic fluid collections).
-         Severe acute pancreatitis ----20 % ( in which there is a pancreatic necrosis, either partial or total ).


4 Comments
mohamed abdel aziz link
12/27/2012 03:38:29 am

great .. would you plz write a note about importance of radiology and medical imaging in the medical field.

Reply
Dr.momen
12/28/2012 07:08:32 am

Nice case and great effort Dr.Ahmed .i want to ask you can i diagnose acute pancreatitis by just swelling of pancrease with out peripancretic fluid collection , and whats the measurment to say the pancrease is enlarged.

Reply
Ahmed Refaey
12/28/2012 08:24:43 pm

Thanks Dr. Momen , there are two types of acute pancreatitis, either mild or severe , the mild form is either edematous ( only swelling of the pancreas ) , or exudative ( associated with peripancreatic fluid collection ) , the severe form is known as necrotic pancreatitis either partial or complete , so the diagnosis of pancreatic necrosis is very important as it differentiate the mild form from the severe form , the mortality rate of mild form is 1% for the mild edematous , and 5% for the mild exudative, while the mortality rate of severe partial necrotizing reachs up to 70% depending on the amount of the involved pancreatic tissue and 100% for the total necrotizing . so the edematous form is only swelling of the gland without peripancreatic fluid collection , and the normal measurement of pancreas on CT study is 2.5 cm of the head and 2 cm for the body and tail in AP diameter

Reply
Hanan Morsy
1/13/2013 11:47:52 pm

Very Nice Case really , i Understand a lot , Jazak allah 5eeR

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