Diagnostic ultrasound ( PDFDrive )

CHAPTER 7 The Pancreas 225
(anterior) to the head and uncinate process of the pancreas.
Spread of inlammation along perivascular spaces, especially the
splenic vein and splenoportal conluence, is characteristic of
acute pancreatitis (Figs. 7.33, 7.34, and 7.35; see also Figs. 7.22,
7.24, and 7.26). his perivascular inlammation may explain why
some patients develop thrombosis of the portal veins (Figs. 7.36
and 7.37; see also Fig. 7.34). Occasionally, retroperitoneal indings
similar to those seen in acute pancreatitis can be seen in patients
with ascites, perhaps because of a “leaky” peritoneum.
Complications
Complications of acute pancreatitis can be classiied as systemic
complications (those related to organ failure) and local
complications. 34,68
Local Complications of Acute Pancreatitis
Acute luid collections
Pseudocysts
Pancreatic abscess
Necrosis
Infected necrosis
Hemorrhage
Venous thrombosis
Pseudoaneurysms
RK
Liver
M
RK
FIG. 7.28 Inlammation Simulates Free Fluid. Longitudinal image
of right upper quadrant shows that the acute inlammation (arrows) in
the anterior pararenal (retroperitoneal) space simulates free luid and
might be mistaken for ascites. Note the retroperitoneal inlammatory
mass (M). RK, Right kidney.
FIG. 7.30 Inlammation in Right Anterior Pararenal and Perirenal
Spaces. Longitudinal coronal image of right upper quadrant, with
decubitus position facilitating visualization of the pararenal and perirenal
spaces. The inlammation partially outlines the perirenal space (arrow),
which is contained by Gerota fascia.
A
B
FIG. 7.29 Pancreatitis-Associated Fluid Collection. (A) Transverse sonogram and (B) computed tomography image of a “lesser sac” luid
collection. Such collections are actually in the prepancreatic retroperitoneum. Note the displaced stomach (arrows). See also Video 7.3.