Acute Pancreatitis

Acute pancreatitis is an uncommon clinical entity in children that is caused by a wide variety of etio-logical agents, the most common of which is blunt abdominal trauma. Other causes include viral infections, drugs, and hereditary abnormalities. Clinical presentation depends on the severity of the disease, but abdominal pain is invariable. Other symptoms are vomiting, fever, jaundice, and an abdominal mass if a pseudocyst is present. When pancreatitis is suspected in a child, US should be the primary imaging investigation (Berrocal et al. 1995). The most common US finding is diffuse or focal glandular enlargement and decreased echogenicity, with poorly defined borders (Fig. 1.79). Dilatation of the pancreatic duct may be present. In cases of mild pancreatitis the pancreas may appear normal on US. CT or MRI are usually reserved for patients with complications, especially those requiring intervention. CT shows diffuse pancreatic enlargement, het-

Hepatobiliary Scan
Fig. 1.78. Choledochal cyst. Transverse US scan through the liver shows a cystic mass (C) in the porta hepatis. Hepatobiliary scintigraphy confirmed communication of the cystic structure with the biliary system. P, portal vein

erogeneous attenuation, a poorly defined pancreatic contour, and peripancreatic fluid collections, which are most commonly found in the anterior pararenal space and lesser sac (Baltazhar 2002). More than one third of patients with acute pancreatitis have an initially normal CT. MRI should be preferred to CT when available because of the lack of ionizing radiation. Pseudocyst formation is the most common complication of the acute pancreatitis and b a

Reading Week Ultrasound

Fig. 1.79. Acute pancreatitis. Diffuse acute pancreatitis in a 5-year-old girl with acquired immunodeficiency syndrome. Transverse US scan through the pancreas shows a globally enlarged pancreas with diffuse decreased echogenicity and irregulars borders (arrows). Note the poor definition of the splenic vein. Gallbladder (gb), left lobe of the liver (LL)

Fig. 1.79. Acute pancreatitis. Diffuse acute pancreatitis in a 5-year-old girl with acquired immunodeficiency syndrome. Transverse US scan through the pancreas shows a globally enlarged pancreas with diffuse decreased echogenicity and irregulars borders (arrows). Note the poor definition of the splenic vein. Gallbladder (gb), left lobe of the liver (LL)

Fig. 1.80. Pseudocyst. Transverse US scan through the pancreas shows a cystic mass (c) with posterior reinforcement anterior to the pancreatic tail (arrows). Left lobe of the liver (LL)

Fig. 1.80. Pseudocyst. Transverse US scan through the pancreas shows a cystic mass (c) with posterior reinforcement anterior to the pancreatic tail (arrows). Left lobe of the liver (LL)

they are the most usual type of cysts occurring in the pancreas. Pseudocysts may be extrapancreatic (usually in the lesser sac) or intrapancreatic, and require at least 4 weeks following an episode of acute pancreatitis. On US they appear as anechoic structures with well-defined borders and posterior reinforcement (Fig. 1.80). These lesions are usually homogeneous, and of water signal intensity on T1-weighted and T2-weighted HASTE images (Ly and Miller 2002) (Fig. 1.12b,c). Pancreatic abscesses can have imaging features similar to pseudocysts, but may be distinguished by means of the clinical history or when there is gas within the collection (Baltazhar 2002) (Fig. 1.81).

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