title: MPR-hCT imaging of the pancreatic fluid pathway to Grey-Turner's and Cullen's sign in acute pancreatitis.
abstract: Subcutaneous manifestations (Grey Turner's sign and Cullen's sign) of severe acute pancreatitis (SAP) are often discussed but rarely observed in a daily clinic setting. This paper will demonstrate the anatomic pathways followed by the extravasated pancreatic enzymes and how their effects lead to these ecchymoses by multiplanar reformation (MPR) images obtained by helical computed tomography (hCT). A 34-year-old female was admitted with SAP. A hCT scan revealed a swollen pancreas and cholecystolithiasis. The fluid collection around the pancreas extended to the pelvic cavity, infiltrating subcutaneous tissue in the left anterior and lateral abdominal wall. She was treated with interventional endoscopy (IVE) and continuous arterial infusion (CAI) therapy immediately following admission, she survived the SAP and these ecchymoses resolved within 7 days of presentation. MPR images obtained by hCT revealed that, the infiltration of the extra-pancreatic fluid collection between the leaves of the anterior renal fascia through the anterior and posterior pararenal space had reached into a relationship with the subcutaneous tissues in the left flank at the clinical site of discoloration as the pathway of extension to Grey Turner's sign, and also revealed anterior extension from the inflamed gastrohepatic ligament and across the falciform ligament to Cullen's sign.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Ichihara Hospital, Chiba, Japan. sugimoto@med.teikyo-u.ac.jp
authors.forename: Maki
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Hideki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Ikuo
authors.initials: I
authors.lastname: Nagashima
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Uchida
authors.forename: Takahiro
authors.initials: T
authors.lastname: Isaka
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Kenji
authors.initials: K
authors.lastname: Takagi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kato
authors.forename: Koji
authors.initials: K
authors.lastname: Takeshita
mesh_terms: D034861:Abdominal Wall / Q000473:pathology / Q000503:physiopathology; D000208:Acute Disease; D000328:Adult; D001826:Body Fluids; D004438:Ecchymosis / Q000209:etiology*; D005260:Female; D006801:Humans; D010179:Pancreas / Q000201:enzymology*; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D010808:Physical Examination; D040521:Subcutaneous Tissue / Q000473:pathology / Q000503:physiopathology; D036542:Tomography, Spiral Computed