0:00

Okay, here's another abdominal CT scan with contrast.

0:04

As we come down, we're going to see a tiny

0:05

bit of hepatic biliary ductal dilatation.

0:07

Again, we can see that this patient has had

0:09

a cholecystectomy, but really what stands out

0:12

here is the extreme amount of fluid around

0:15

the pancreas, all in that peripancreatic fat,

0:18

and additionally down into the paracolic gut.

0:21

This, my friends, is pancreatitis.

0:23

But then when we look at the pancreas,

0:24

the pancreas is all enhancing normally.

0:27

So this is a case of interstitial

0:29

pancreatitis without evidence of necrosis.

0:32

At this time.

0:33

There is fluid both around the pancreatic stroma.

0:36

On both the deep and superficial surfaces, and

0:38

there's also fluid here going posterior to the colon.

0:42

This is in the anterior pararenal space,

0:45

which is where the pancreas lies in the

0:47

body, so you'll frequently see that fluid.

0:49

It's not free intraperitoneal fluid.

0:51

It's actually kind of contained in

0:52

that anterior pararenal space, all

0:55

the way down into the lower abdomen.

0:57

So this is a nice case of interstitial,

1:00

non-necrotic acute pancreatitis.

1:03

You can see here the beautiful splenic vein that

1:05

is very close to the pancreas, is enhancing normally

1:07

without evidence of splenic vein thrombosis.

1:10

Alright, let's take a second case here.

1:13

This is another patient, a separate

1:15

patient who came in with pancreatitis.

1:16

You can see that the liver here is

1:17

slightly low in attenuation, consistent

1:19

with fatty infiltration of the liver.

1:21

That could be an indication of

1:23

the cause for the pancreatitis.

1:25

In this case, there's also some free fluid, and in

1:28

this case, when we look at the pancreas, you can see

1:30

that there's a definite differential for enhance—

1:33

of the pancreatic head here comparatively

1:35

to the pancreatic body, especially

1:36

when you window and level it.

1:38

You can see that the pancreatic head here lacks the

1:40

normal enhancement that we saw in our previous case.

1:43

So this would be a case of a patient who has

1:46

pancreatitis, again, free fluid, all in those

1:48

paracolic gutters in that anterior pararenal.

1:52

But in this case, the pancreas has a

1:55

lack of enhancement, so that would be an

1:56

indication that you have pancreatic necrosis.

1:59

We can look at it on coronals as well.

2:01

Not as easy to look at the pancreas on coronals.

2:03

It's not my favorite coronal organ.

2:05

I usually look at kidneys and colon on coronal, but

2:08

I think the pancreas is best evaluated on axials.

2:10

But again, you can see that lack of

2:13

enhancement in the pancreatic head.

2:16

The splenic vein here is nicely enhancing.

2:18

We don't have any problems with that, so that's good.

2:21

But in general, this is an indication

2:23

that this patient has a higher level of

2:24

pancreatitis with pancreatic necrosis.

2:27

This will cause more problems for this patient than a

2:29

simple interstitial pancreatitis as we saw earlier.