Friday, March 15, 2013

Splenic Abscess

The CECT images above are from a patient who underwent sleeve gastrectomy (blue arrow) and experienced worsening abdominal pain in the weeks that followed. She was admitted with sepsis. There are necrotic areas within the spleen and multiple rim enhancing collections of air and fluid (red arrows) compatible with abscesses. Left upper quadrant fluid collections (sterile and infected) are a known complication of bariatric surgery.

Blachar A and Federle MP. Gastrointestinal complications of Roux-en-Y gastric bypass surgery in patients who are morbidly obese: findings on radiography and CT. AJR Am J Roentgenol 2002;179:1437-42.
Yu J, Turner MA, Cho SR, et al. Normal anatomy and complications after gastric bypass surgery: helical CT findings. Radiology 2004;231:753-60.

Wednesday, March 6, 2013

Necrotizing Pancreatitis

Necrotizing pancreatitis is perhaps the most severe complication of acute pancreatitis because of the high associated mortality rate.  Bacterial contamination of pancreatic necrosis carries a 40-70% mortality rate, even after surgical debridement. Thus, early detection of necrosis is crucial in patient management. 

CECT will show lack of enhancement of the necrotic regions.  This finding is usually accompanied by other imaging indicators of pancreatitis such as infiltration of the peripancreatic fat planes. T2W MRI will show increased signal intensity of the necrotic regions while T1W post contrast images will show nonenhancing areas with decreased signal intensity. 

The above CECT images are from a young male admitted with acute pancreatitis whose clinical status was worsening. Lack of enhancement of the distal pancreatic body and tail are seen (red arrow)  consistent with necrosis. Note, the normal enhancement of the pancreatic head (blue arrow).

Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 2002;23:603-13.
O'Connor OJ, Buckley JM, Maher MM. Imaging of the complications of acute pancreatitis. AJR Am J Roentgenol 2011;197:W375-81.