• Imaging of the Complications of Acute Pancreatitis

    AJR: 197, September 2011

    Owen J. O'Connor, Julliette M. Buckley, Michael M. Maher

    Educational Objectives

    • The Atlanta classification system is most commonly used to classify the severity of acute pancreatitis but does not provide exact radiologic criteria for classifying the complications of acute pancreatitis. A revision of the Atlanta criteria is under way and alternative more specific descriptive terms have been suggested.
    • The severity of acute pancreatitis may be classified radiologically using the CT severity index. This system scores the extent of pancreatic fluid collections and necrosis and has been shown to have prognostic accuracy for the subsequent development of complications. 
    • A fluid collection in the setting of acute pancreatitis may be an acute fluid collection, a pseudocyst, or an abscess. 
    • Pancreatic necrosis is considered one of the most significant complications of acute pancreatitis because the presence and extent of necrosis help predict the likelihood of future morbidity and mortality. 
    • Management of the complications of severe acute pancreatitis is frequently very challenging, requiring a multidisciplinary approach involv­ing the intensivist, medical physician, surgeon, and radiologist. For example, differentiating necrosis from an abscess can be difficult and the expertise of multiple clinicians may be necessary for definitive diagnosis. The distinction between pancreatic necrosis and abscess is important because an abscess has a better prognosis and can be treated with percutaneous drainage, whereas interventional radiology has a limited role or no role in the management of necrosis, with surgery and necrosectomy being necessary in severe cases.