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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Computed tomography (CT) and in particular multi-detector row computed tomography (MDCT), also known as multislice CT (MSCT), is ideally suited for detecting pancreatic tumors because of the high spatial resolution.The method of choice is hydro-CT which involves distension of the stomach and duodenum by administration of 1-1.5 l water as a negative contrast medium under medically induced hypotension by administration of buscopan. The patient is laid on the right side at an angle of 30-45 degrees in order to obtain an artefact-free image of the close anatomical relationship around the pancreas head. In addition, curved MPRs or in rare cases 3D reconstructions could be very helpful in identifying the critical anatomic tumor site in the neighbourhood of the visceral vessel system. After the correct diagnosis of an adenocarcinoma has been made only 20% of all patients are shown to have a surgically resectable disease, but the overall survival rate is significantly higher after resection in combination with a multimodal tumor therapy strategy. The reason is that the correct diagnosis of the resectability of the tumor is one of the main criteria for overall survival of these patients. Currently practically all pancreatic tumors can be detected using MDCT and the detection rate varies between 70% and 100% (most recent literature references give a sensitivity of 89% and specificity up to 99%). In some rare cases the differentiation between focal necrotizing pancreatitis and pancreatic carcinoma can be difficult even with sophisticated protocols. Resectability can be correctly diagnosed with MDCT with a sensitivity of 94% and a specificity of 89%. MDCT is an ideal tool for the detection of neuroendocrine tumors, metastases and for the differentiation of cystic pancreatic lesions such as pseudocysts, microcystic adenomas or intraductal papillary mucinous neoplasms (IPMN). Particularly, the differentiation of the latter into benign, borderline or malignant transformation is not always possible, but indirect signs, such as small nodules adjacent to the ductal wall, the diameter of the pancreatic duct, or a direct communication between cystic lesions and duct can be detected because of the high spatial resolution and is comparable to the findings in MRI. Moreover MD-CT is an ideal procedure for the differentiation of local tumor stages in patients under neoadjuvant or adjuvant chemotherapy.
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PMID:[Computed tomography of pancreatic tumors]. 1913 77

We report a case of histopathologically proven autoimmune pancreatitis in an 11-year-old boy. Abdominal US and MRI showed a focal swelling of the pancreatic head, the latter also showing delayed contrast enhancement. There was diffuse irregular pancreatic duct narrowing, compression of the intrapancreatic common bile duct, and mild proximal biliary dilatation on MR cholangiopancreatography. Laboratory results revealed normal serum IgG and subclass 4 with negative autoimmune antibodies, and slightly elevated carbohydrate antigen 19-9. This highlights the differentiation of autoimmune pancreatitis from pancreatic head cancer and, to a lesser extent, other forms of pancreatitis in children.
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PMID:Autoimmune pancreatitis in an 11-year-old boy. 1919 Aug 99

It is difficult to make an accurate radiological diagnosis of a pancreatic tumor because of its location and anatomical characteristics. Mass-forming pancreatitis and pancreatic cancer are particularly difficult to differentiate. New diagnostic technology, which includes diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI) and 2-[(18)F]-fluoro-2-deoxy-Dglucose positron emission tomography (FDG-PET), offers hope for the detection of classical pancreatic cancer. Few studies have been conducted on FDG-PET and DWI-MRI as tools used to distinguish between mass-forming pancreatitis and pancreatic cancers. Furthermore, positive findings of mass-forming pancreatitis on DWI-MRI and FDG-PET have yet to be documented. We report a case of a pancreatic head tumor, present on FDG-PET and DWI-MRI which, on closer examination, revealed benign mass-forming pancreatitis. We discuss the utility of FDG-PET and DWI-MRI as preoperative diagnostic tools.
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PMID:Mass-forming pancreatitis with positive fluoro-2-deoxy-D: -glucose positron emission tomography and positive diffusion-weighted imaging-magnetic resonance imaging: Report of a case. 1919 97

This retrospective study analyzes, whether patients suffering from extensive hepatic metastatic disease treated with SIRT can become suitable candidates for RFA.Within 38 months 46 patients (26 female, 20 male; age 32-75 years) bearing an extensive hepatic metastatic disease were treated with SIRT. Patients suffered from metastases of breast cancer (16/46), colorectal cancer (CRC) (21/46), neuroendocrine (3/46), and other primary carcinomas (6/46). The indication for SIRT was otherwise untreatable metastases confined to the liver. Forty-three patients received single-session whole-liver radioembolization treatment using Yttrium90 resin microspheres with a mean activity of 2.13GBq. In 1 patient SIRT was confined to the left and in 2 patients to the right liver lobe. In 3 patients major complications (2/3 gastric ulceration and 1/3 oedematous pancreatitis) and in 24 patients minor complications occurred (acute abdominal/epigastric pain and/or nausea). Follow-up CT and/or MRI were obtained in 44 of 46 patients. In 5 of 44 patients tumor load decreased substantially (3/5 breast cancer, 1/5 CRC and 1/5 pancreatic cancer) making RFA feasible. The patients were referred for RFA after the first 3-month follow-up. RFA of the liver was successful in all cases in terms of complete ablation. In selected patients radioembolization is able to downstage liver metastases to an extent making a subsequent RFA suitable and therefore allows increasing the number of patients with a "complete response" after a minimally invasive therapy.
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PMID:Radiofrequency ablation after selective internal radiation therapy with Yttrium90 microspheres in metastatic liver disease-Is it feasible? 1926 63

Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic fibroinflammatory disorder. It has been recognized as a distinct clinical entity, only recently. Multiple organs, such bile ducts, salivary glands, kidneys and lymph nodes, can be involved either synchronously or metachronously. It is one of the few autoimmune conditions that predominantly affects male subjects in the fifth and sixth decades of life. Obstructive jaundice is the most common presenting symptom but the presentation can be quite nonspecific. There are established diagnostic criteria to diagnose AIP, most of which rely on a combination of clinical presentation, imaging of the pancreas and other organs (by CT scan, MRI and endoscopic retrograde pancreatography), serology, pancreatic histology and response to steroids to make the diagnosis. It is imperative to differentiate AIP from pancreatic cancer owing to the vastly different prognostic and therapeutic implications. AIP responds dramatically to steroid treatment but relapses are common. Relapse of AIP can often be retreated with steroids. As the collective experience with this condition increases, a better understanding of the natural history of this disease is emerging.
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PMID:Autoimmune pancreatitis: an update. 1935 Dec 89

Practical guidelines for the diagnosis of acute pancreatitis are presented so that a rapid and adequate diagnosis can be made. When acute pancreatitis is suspected in patients with acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of acute pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other acute abdominal diseases are ruled out if local findings associated with pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having acute pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting acute pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of acute pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of acute pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of acute pancreatitis. Elucidation of the etiology of acute pancreatitis should be continued after a diagnosis of acute pancreatitis. In the process of the etiologic elucidation of acute pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced acute pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.
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PMID:New diagnostic criteria of acute pancreatitis. 2001 28

Acute pancreatitis is a rare initial presentation of non-Hodgkin lymphoma with few reported cases described in older adults and even fewer in children. MRI features of Burkitt lymphoma of the pancreas are sparse in the radiologic literature. We present a 6-year-old boy who presented with pancreatitis and obstructive jaundice, which was the result of Burkitt lymphoma of the pancreas. The imaging findings of pancreatic involvement of Burkitt lymphoma on MRI are discussed and the contributory role of the radiologist in guiding the appropriate clinical work-up of this disease is highlighted.
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PMID:Pediatric Burkitt lymphoma presenting as acute pancreatitis: MRI characteristics. 2013 16

Acute pancreatitis affects around 40 per 100.000 of the general population and 20-30% of attacks are severe. Mortality is usually associated to septic multiorgan dysfunction syndrome caused by secondary infection of pancreatic or peripancreatic necrosis. The diagnosis of acute pancreatitis is generally based on clinical and laboratory findings. However CT is the imaging technique of choice for detecting complications. Patients with complicated pancreatitis require multiple follow-up examinations. Substitution of US or MRI for CT in certain cases would reduce the radiation dose considerably. Complicated pseudocysts and other pancreatic collections may contain solid debris, which is best depicted by MRI. Abscesses are suggested when gas is present in a pancreatic or peripancreatic collection. MRI can reveal air-fluid levels or large pockets of gas, but CT is more sensitive for small gas collections. US or CT-guided percutaneous drainage of pancreatic abscesses or infected collections is a useful therapeutic approach in acute cases obviating the need for unnecessary surgery. On the other hand infected necrosis can not be successfully treated percutaneously due to its thicker consistency. In this review, the role of different imaging modalities in the evaluation of post-pancreatitis infection as well as in the treatment planning will be discussed.
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PMID:Imaging evaluation of post-pancreatitis infection. 2018 Jul 54

Cystic lesions of the pancreas are identified with increasing frequency by modern imaging. The mucinous cystic neoplasm (MCN) is treated with resection for its malignant potential. How much preoperative evaluation is needed before undertaking operation is frequently a diagnostic dilemma. A retrospective review of 32 patients who underwent resection of a MCN between 1994 and 2007 was performed to define the preoperative evaluation and operative treatment of MCN patients. Thirty-two patients (30 women; mean age 49) had histology-proven MCN. Twenty-seven patients had symptomatic cysts (84%). Five had a history of gallstones and/or acute pancreatitis. All patients were worked up with CT and/or MRI. Endoscopic ultrasound was performed in 14 (44%) and endoscopic retrograde cholangiopancreatography in six (18%). Cytology was obtained in 13 (40%). Pathology revealed 22 benign MCNs (68%), five malignant MCNs (16%), and five MCNs with borderline pathology. Preoperative workup including CT or MRI imaging and cytology suggested MCN as the lesion in 15 patients (46%). CT features by itself predicted MCN in three patients (9%). Cytology revealed another six patients (19%) with possible MCN. In this series, preoperative workup did not identify three of five patients with MCN malignancy. A preoperative diagnosis cannot be made in most patients with MCN. Operative treatment can be based on clinical presentation and CT imaging because endoscopic ultrasound and fine needle aspiration for evaluation may be misleading. Middle-aged women with cystic lesions in the tail of the pancreas without prior gallstone or pancreatitis history most typically fit the profile of the MCN patient.
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PMID:Mucinous cystic neoplasms of the pancreas: how much preoperative evaluation is needed? 2072 9

Celiac artery trunk thrombosis is a rare complication of pancreatitis. Only two other cases have been reported in the English-language literature. Here, we present the clinical and multimodality imaging findings for a woman with pancreatitis who had continued pain after normalization of pancreatic enzyme levels and was unexpectedly found to have occlusion of her celiac trunk on follow-up MRI. She was managed as an outpatient and had spontaneous resolution 2 weeks later.
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PMID:Celiac artery trunk thrombosis: an unusual complication of pancreatitis diagnosed on MRI. 2123 21


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