Clinical and Imaging Modalities of Acute Pancreatitis

Acute Pancreatitis is an inflammatory disease of pancreas producing temporary changes with potential for restoration of normal anatomy and function following resolution.

Clinical Presentation of acute pancreatitis

• Acute epigastric pain radiating to back/chest (peaking after a few hours, resolving in 2-3 days)
• Nausea, vomiting
• Raised pancreatic amylase + lipase in blood + urine
• Increased amylase-creatinine clearance ratio
• Signs of hemorrhagic pancreatitis:
• Cullen sign = periumbilical ecchymosis
• Grey-Turner sign = flank ecchymosis
• Fox sign = infrainguinal ecchymosis
• Subcutaneous nodules + fat necrosis + polyarthritis

Filed under: Acute Pancreatitis, Gastrointestinal Emergency , Acute Pancreatitis

CT Findings of Acute Appendicitis

CT has 87-100% sensitive and89-98% specific  of diagnosis acute appendicitis.

CT findings of normal appendix

• Visualized in 67-100%.
• AT posteromedial aspect of cecum.
• Diameter of up to 10 mm.

CT findings of Abnormal appendix

• Distended lumen (appendix >7 mm in diameter).
• Circumferential wall thickening.
• Target sign:  homogeneously enhancing wall with mural stratification.
• Appendicolith:  homogeneous/ringlike calcification (25%).
• Distal appendicitis: abnormal tip of appendix + normal proximal appendix and normal cecal apex.

Filed under: Acute Appendicitis, Gastrointestinal Emergency , Acute Appendicitis, Arrowhead sign, CT Findings, normal appendix, Target sign

Graded-compression Ultrasound in acute appendicitis

Ultrasound has 85% sensitive and 92% specific with 78-96% accurate. Nondiagnostic study in 4% due to inadequate compression of RLQ. Useful in ovulating women (false-negative appendectomy rate in males 15%, in females 35%) + infants/children

Findings of acute appendicitis of ultrasound:

• Visualization of noncompressible appendix as a blind-ending tubular aperistaltic structure (seen only in 2% of normal adults, but in 50% of normal children)
• Laminated wall with target appearance of 6 mm in total diameter on cross section (81% SPECIFIC)/mural wall thickness 2 mm
• Lumen may be distended with anechoic/hyperechoic material
• Pericecal/periappendiceal fluid
• Increased periappendiceal echogenicity (= infiltration of mesoappendix/pericecal fat)
• Enlarged mesenteric lymph nodes
• Loss of wall layers = gangrenous appendix

Filed under: Acute Appendicitis, Gastrointestinal Emergency , Acute Appendicitis, Ultrasound