Chronic Pancreatitis

Chronic Pancreatitis
Brooke R. Jeffrey, MD
Michael P. Federle, MD, FACR
Key Facts
Terminology
  • Irreversible inflammatory damage to pancreas, usually evident on imaging or functional testing
Imaging
  • Approximately 90% of cases of calcific pancreatitis are due to alcoholism
    • Other 10% = mostly hereditary pancreatitis
  • Atrophy of gland, dilated main pancreatic duct (MPD), intraductal calculi
    • Fibroinflammatory mass: Common in pancreatic head
  • May have “double duct” sign (stricture of distal CBD and pancreatic duct)
    • Not pathognomonic of pancreatic carcinoma
    • Long, smooth taper of CBD (not abrupt, as with carcinoma)
    • MRCP: Good depiction of parenchymal and ductal lesions
  • Splenic vein thrombosis, splenomegaly, varices
    • May progress to thrombosis of portal vein
  • Pseudoaneurysm of gastroduodenal or other arteries
    • Detected by US, CTA, or MRA
Top Differential Diagnoses
  • Pancreatic ductal carcinoma
  • Pancreatic IPMN
  • Senescent change
Pathology
  • Gallstones, hyperlipidemia, trauma; drugs often cause acute and recurrent, but rarely chronic, pancreatitis
  • Genetic predisposition toward pancreatitis from alcohol
(Left) Transverse grayscale ultrasound of the pancreas demonstrates a dilated main pancreatic duct image upstream from an obstructing intraductal stone image. (Right) Axial CECT in the same patient shows marked parenchymal atrophy and dilatation of the main pancreatic duct image. Note the large intraductal stone image in the neck of the pancreas as well as a dilated common bile duct image. There is fluid in the lesser sac image from acute pancreatitis. This is an example of acute and chronic pancreatitis.
(Left) Axial T2WI shows an irregularly dilated main pancreatic duct image associated with glandular atrophy in the body-tail segments of the pancreas image. (Right) Axial NECT of a 27-year-old man with familial pancreatitis shows extensive calcification and atrophy of the pancreas image. Over 90% of patients with chronic calcific pancreatitis have alcohol as the etiology. There is a genetic predisposition to chronic pancreatitis, however, and some patients have no history of alcohol use or abuse.
TERMINOLOGY
Definitions
  • Irreversible inflammatory damage to pancreas, usually evident on imaging or functional testing
IMAGING
General Features
  • Best diagnostic clue
    • Atrophy of gland, dilated main pancreatic duct (MPD), intraductal calculi
  • Size
    • Pancreas usually decreased in size (atrophy)
  • Morphology
    • Inflammatory disease of pancreas characterized by irreversible damage to morphology and function
    • Pancreatic calcification
      • Almost diagnostic of chronic pancreatitis
      • Approximately 90% of calcific pancreatitides are caused by alcoholism
        • Other 10% = mostly hereditary pancreatitis
      • 40-60% of patients with alcoholic pancreatitis
  • Other features
    • 75% of cases in USA are due to alcoholism
    • Developing countries: Malnutrition and alcoholism
Radiographic Findings
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Sep 20, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Chronic Pancreatitis

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