Imaging

Pancreatic Abscess

Preliminary Diagnosis: Pancreatic Abscess

I. What imaging technique is first-line for this diagnosis

  • CT scan of the abdomen and pelvis with po and intravenous contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic abscess.

Advantages

  • Highly sensitive and specific in detecting a primary abnormality, such as an abscess, and detecting and characterizing any secondary complications

  • May help guide treatment and therapy

  • Offers exquisite detail of the surrounding anatomical structures

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR of the abdomen and pelvis with IV contrast

  • Ultrasound

  • ERCP

  • MRCP.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic abscess.

MR of the abdomen and pelvis with IV contrast

Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite detail of the surrounding soft tissues and helps characterize the extent of soft tissue invasion and extension

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Offers poor evaluation of the surrounding vascular and soft tissues

  • Less adept in guiding treatment

Ultrasound

Advantages

  • Highly portable imaging modality

  • May help guide percutaneous treatment and therapy

  • Offers exquisite visualization of any surrounding vascularity

Disadvantages

  • Less adept in detailing the surrounding anatomical structures

ERCP

Advantages

  • Offers the opportunity for simultaneous diagnostic evaluation and therapeutic treatment

  • May offer better anatomical detail of the pancreatic process and surrounding soft tissues

Disadvantages

  • Invasive procedure associated with greater morbidity and mortality

MRCP

Advantages

  • Offers exquisite anatomical detail of the intrahepatic and extrahepatic biliary tree and pancreatic ducts

  • Does not expose patients to ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

MR of the abdomen and pelvis with IV contrast

  • Contraindicated in patients with non–MR-compatible hardware

Ultrasound

  • No specific contraindications exist.

ERCP

  • Contraindicated in patients with a severe hypocoagulable state

MRCP

  • Contraindicated in patients with non–MR-compatible hardware

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