Acute pancreatitis CT

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]


Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[1] . In addition, CT contrast may exacerbate pancreatitis,[2] although this is disputed.[3][4]


Regarding the need for computed tomography, practice guidelines state:

2006: "Many patients with acute pancreatitis do not require a CT scan at admission or at any time during the hospitalization. For example, a CT scan is usually not essential in patients with recurrent mild pancreatitis caused by alcohol. A reasonable indication for a CT scan at admission (but not necessarily a CT with IV contrast) is to distinguish acute pancreatitis from another serious intra-abdominal condition, such as a perforated ulcer." [5][4]
2005: "Patients with persisting organ failure, signs of sepsis, or deterioration in clinical status 6–10 days after admission will require CT (recommendation grade B)."[6]

CT abdomen should not be performed before the 1st 48 hours of onset of symptoms as early CT (<48 h) may result in equivocal or normal findings.

CT findings can be classified into the following categories for easy recall :

Balthazar Scoring

Balthazar Scoring for the grading of acute pancreatitis:

  • The CT severity score is the sum of the CT Grade and Necrosis Grade Scores.
CT Grade Score:
CT Grade Appearance on CT CT Grade Points
Grade A Normal CT 0 points
Grade B Focal or diffuse enlargement of the pancreas 1 point
Grade C Pancreatic gland abnormalities and peripancreatic inflammation 2 points
Grade D Fluid collection in a single location 3 points
Grade E Two or more fluid collections and / or gas bubbles in or adjacent to pancreas 4 points
Necrosis score:
Necrosis Percentage Points
No necrosis 0 points
0 to 30% necrosis 2 points
30 to 50% necrosis 4 points
Over 50% necrosis 6 points
Case courtesy of Dr Rahmoun Fateh, <a href=""></a>. From the case <a href="">rID: 18850</a>
Case courtesy of <a href=""></a>. From the case <a href="">rID: 11163</a>
Case courtesy of David Puyó, <a href=""></a>. From the case <a href="">rID: 22434</a>


  1. Fleszler F, Friedenberg F, Krevsky B, Friedel D, Braitman L (2003). "Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis". Am J Med Sci. 325 (5): 251–5. PMID 12792243.
  2. McMenamin D, Gates L (1996). "A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis". Am J Gastroenterol. 91 (7): 1384–7. PMID 8678000.
  3. Hwang T, Chang K, Ho Y (2000). "Contrast-enhanced dynamic computed tomography does not aggravate the clinical severity of patients with severe acute pancreatitis: reevaluation of the effect of intravenous contrast medium on the severity of acute pancreatitis". Arch Surg. 135 (3): 287–90. PMID 10722029.
  4. 4.0 4.1 Forsmark CE, Vege SS, Wilcox M (November 17,2016). "Acute Pancreatitis". The New England Journal of Medicine: 1972–1981. doi:10.1056/NEJMra1505202. Retrieved November 25,2016. Check date values in: |access-date=, |date= (help)
  5. Banks P, Freeman M (2006). "Practice guidelines in acute pancreatitis". Am J Gastroenterol. 101 (10): 2379–400. doi:10.1111/j.1572-0241.2006.00856.x. PMID 17032204.
  6. UK Working Party on Acute Pancreatitis (2005). "UK guidelines for the management of acute pancreatitis". Gut. 54 Suppl 3: iii1–9. doi:10.1136/gut.2004.057026. PMID 15831893.

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