Friday, September 21, 2012
Acute pancreatitis can progress to emphysematous pancreatitis when superinfection with a gas forming organism occurs. Other causes for intraductal or parenchymal pancreatic gas include end organ infection, enteric fistula, iatrogenic (post endoscopic instrumentation), and reflux from the duodenum after sphincterotomy. The diagnosis carries a poor prognosis and requires aggressive treatment with antibiotics with possible debridement or drainage.
CT is the best modality to detect emphysematous pancreatitis. In addition to retroperitoneal air within and surrounding the pancreas (as on the above images), complications such as abscess formation and necrosis may seen.
The liver findings on the above images are discussed here.
Grayson DE, Abbott RM, Levy AD, et al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics 2002;22:543-61.