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