Comparative study of ultrasonography versus computed tomography in evaluation of pancreatitis

Abstract

Pancreatitis is one of the commonest causes of morbidity and mortality in patients
presenting to the emergency.
1
It is an infrequent disease exemplified by pancreatic
inflammation. It is classified into acute and chronic pancreatitis according to clinical and
morphological criteria. The Southern states of India have reported to have highest
incidences of Pancreatitis, ranging from 114-200/100,000 population.3 Acute pancreatitis
occurs in approximately 50,000–80,000 Americans each year.4 However, true prevalence
of chronic pancreatitis is not known as many patients with unexplained abdominal pain may
have been suffering from chronic pancreatitis that eludes diagnosis. Chronic pancreatitis
can be demonstrated in 0.04% to 5% of autopsies.
5
Incidence of chronic pancreatitis in
western population ranges from 8 to10 cases per year per 100,000 population, and the
overall prevalence is 27.4 cases per 100,000 population.6
Acute or chronic pancreatitis may possibly be correlated with pancreatic calcification,
pseudocysts, extra pancreatic phlegmons, haemorrhage and pancreatic necrosis/abscess
formation which can help the radiologist to make an accurate diagnosis.7
It is important to define and stratify the severity of acute pancreatitis for the appropriate
management of the patients. Based on transient or persistent organ failure, and local or
systemic complications, the severity of acute pancreatitis is classified into three degrees: mild
acute pancreatitis, moderately severe acute pancreatitis, and severe acute pancreatitis.
8
According to the Atlanta classification (2012), acute pancreatitis can be classified as
interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis. Pancreatic and
peripancreatic collection can be categorized into acute peripancreatic fluid collection
(APFC), pancreatic pseudocyst, acute necrotic collection (ANC), and walled-off necrosis
(WON), based on location (pancreatic, peripancreatic), the nature of the content (liquid,
solid, gas), and the presence of wall.
8
Complications of acute pancreatitis are categorized as the following: (1) organ failure, (2)
systemic complications, and (3) local complications.
9 Chronic pancreatitis are recognized as a
large-duct type and a small-duct variant based on the diameter of the main pancreatic duct
(MPD). Abdominal pain is the most predominant clinical finding in patients. Other
associated findings seen are nausea, vomiting, fever and pain radiating to the back. Patients
can also present with additional complications of the disease (e.g., pseudocyst, vascular
thrombosis, or obstruction of adjacent organs); or additional complaints that suggests
endocrine or exocrine pancreatic failure, or both.10