Chronic Pancreatitis



Chronic Pancreatitis


Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR










(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

Sep 20, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Chronic Pancreatitis

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