PMC4896229_01
25-year-old woman with presenting with acute pancreatitis. Contrast enhanced CT during initial clinical presentation. Portal venous phase 5 mm axial MDCT image through the inferior pancreatic head level demonstrates retroperitoneal acute peripancreatic fluid extending throughout the mesenteric root and left anterior pararenal spaces. Pancreatic ascites is also present. No pancreatic glandular necrosis is evident.
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Contrast enhanced abdominal CT (CECT) demonstrated findings consistent with evolving acute pancreatitis including intra- and retroperitoneal fluid, but no defined, drainable fluid collection or glandular necrosis (Figure 1).
25-year-old woman presenting with acute pancreatitis. Three months later, pancreatic parenchymal phase 2.5 mm MDCT image immediately inferior to the pancreatic head shows that the retroperitoneal peripancreatic acute fluid has evolved in to predominately solid, diffusely enhancing soft tissue density (*).
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Repeat CECT obtained as an outpatient three months later showed evolution of fluid density collections into scattered solid enhancing peritoneal nodules, mesenteric implants, and bulky confluent soft tissue encasement of vessels in the mesenteric root (Figure 2, Figure 3).
25-year-old woman with presenting with acute pancreatitis. Three months later, portal venous phase demonstrates enhancement of the mass-like evolving collections that appear to encase the mesenteric root vessels.
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Repeat CECT obtained as an outpatient three months later showed evolution of fluid density collections into scattered solid enhancing peritoneal nodules, mesenteric implants, and bulky confluent soft tissue encasement of vessels in the mesenteric root (Figure 2, Figure 3).
25-year-old woman with presenting with acute pancreatitis. Because of the appearance on imaging, a neoplastic etiology was considered and the patient underwent laparoscopy for tissue sampling. Intraoperative photograph of one of the friable whitish nodules on the peritoneal surface.
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Because of the unusual appearance, exploratory laparoscopy was performed and demonstrated multiple white, friable peritoneal nodules (Figure 4), as well as extensive adhesions due to implants of similar nodules on the serosal bowel surface.
25-year-old woman with presenting with acute pancreatitis. Six months after initial presentation, portal venous phase 5 mm axial MDCT image reveals that the enhancing solid retroperitoneal deposits persist (compare to the ascitic fluid density). The post inflammatory change has an appearance that suggests carcinomatosis rather than the homogeneous, low attenuation more typical for peripancreatic retroperitoneal fat necrosis in patients with evolving acute pancreatitis.
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During a hospitalization six months after the acute pancreatitis episode, the solid enhancing mesenteric root and peritoneal deposits persisted (Figure 5) on CECT.