Medical Image of the Week: Pancreatic Abscess

Figure 1. CT scan of the abdomen showing fluid collections (arrows).

Figure 2. Ultrasound of the abdomen showing a distended pancreatic duct, which communicates to an inferior fluid collection, likely a pseudo-cyst.

Figure 3. Coronal CT of the abdomen and pelvis showing pelvic abscess (arrow). 

A 55 year old woman, with a history of alcohol abuse and necrotizing pancreatitis, was readmitted for worsening abdominal pain and acute respiratory failure. A CT scan of the abdomen and pelvis showed an atrophic pancreas and multiple fluid collections. Along the inferior surface of the pancreas, there is a fluid collection with an evolving loculated rim, which is asymmetric, the larger component measure 2.9 cm x 4.7 cm (Figure 1, large arrow). Anterior to the body of the pancreas, there is an additional 2.2 cm x 2.4 cm with evolving loculated rim (Figure 1, short arrow), both compatible with a pseudocyst.  Ultrasound of the abdomen showed a distended pancreatic duct that communicates to the smaller fluid collection (Figure 2).  Coronal CT of the abdomen and pelvis showed a 12.4 cm pelvic abscess (Figure 3). CT guided drainage of the pelvic abscess was performed with positive culture of the fluid for E. coli. She developed secondary peritonitis and had a successful exploratory laparotomy.

Carmen Luraschi-Monjagatta MD, Mohammed Alzoubaidi MD, and Elizabeth Ulliman MD

Department of Pulmonary, Allergy, Sleep and Critical Care.

Internal Medicine, South Campus.

University of Arizona

Tucson, Arizona

Reference as: Lurachi-Monjagatta C, Alzoubaidi M, Ullman E. Medical image of the week: pancreatic abscess. Southwest J Pulm Crit Care. 2014;8(2):126-7. doi: http://dx.doi.org/10.13175/swjpcc017-14 PDF