Imaging
Pancreatic Abscess
- Preliminary Diagnosis: Pancreatic Abscess
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic abscess.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic abscess.
- VI. What are the contraindications for the alternative imaging techniques?
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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