Wk 2, Case 13 - Review

Report
TECHNIQUE:
CT of the abdomen and pelvis with intravenous contrast.

COMPARISON: None.

FINDINGS:

LOWER THORAX: Small bilateral pleural effusions. There is subsegmental atelectasis of the dependent segments of the bilateral lower lobes.

HEPATOBILIARY: There is diffuse hepatic steatosis.
There is a hepatic attenuation difference between the right and left lobe of the liver, with the right lobe showing greater enhancement. This is likely due to the thrombosis of the right portal vein as described below.
Focal area of hyperenhancement adjacent to the falciform ligament, likely due to alternate vascular drainage through the vein of Sappey.

SPLEEN: No splenomegaly.

PANCREAS: The pancreas is enlarged with peripancreatic inflammatory changes and free fluid tracking down into the pelvis. There are ill defined areas of hypoenhancement in the body, tail and head of the pancreas, involving >30% of the pancreatic parenchyma, which are consistent with areas of necrosis.

ADRENALS: No adrenal nodules.

KIDNEYS/URETERS: Multiple subcentimeter renal cortical cysts. Few non obstructing renal calculi.

PELVIC ORGANS/BLADDER: Unremarkable.

PERITONEUM / RETROPERITONEUM: No free air. There is a small volume of free fluid in the pelvis.

LYMPH NODES: No lymphadenopathy.

VESSELS: There is non opacification of the right portal vein and the splenic vein, consistent with thrombosis. There is also partial thrombosis at the cranial end of the superior mesenteric vein.

GI TRACT: No distention or wall thickening.

BONES AND SOFT TISSUES: No suspicious lytic or blastic lesions are visualized.

IMPRESSION:
1. Acute necrotizing pancreatitis. Small volume ascites. No drainable fluid collections.
2. Thrombosis of the right portal vein, the splenic vein and the cranial part of the superior mesenteric vein.