Computed tomographic differentiation between alcoholic and gallstone pancreatitis: Significance of distribution of infiltration or fluid collection.
OBJECTIVE
To evaluate the usefulness of various computed tomography (CT) findings including distribution of infiltration or fluid collection in differentiating the major etiologies of acute pancreatitis.


METHODS
We reviewed 75 relatively severe cases of acute pancreatitis of alcoholic (n = 43) or biliary stone (n = 32) etiology having infiltration or fluid collection on CT. We compared the pancreatic size, CT grading, presence or absence of biliary calculi, and dilatation of pancreatic or bile duct. We also evaluated degree and the distribution of infiltration and fluid collection in each group.


RESULTS
The sizes of pancreas were not different between alcohol group and stone group. Alcohol group showed higher CT grading than stone group (P < 0.05). Presence of biliary stone and duct dilatation was statistically significant in differentiating etiology (P < 0.05). Alcohol group showed significantly prominent peripancreatic pathology than stone group only in left peritoneal compartment (P = 0.020).


CONCLUSIONS
Alcoholic pancreatitis tends to form more prominent peripancreatic changes than gallstone pancreatitis in relatively severe cases. This is evident on the anterior aspect of left abdomen. Although clinical history and some CT findings usually are a major determinant of the etiology, this pattern of peripancreatic pathology may have an ancillary role in determining the etiologies of acute pancreatitis in the equivocal cases.
Kim
Young-Sun
YS
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Kim
Yongsoo
Y
Kim
Sung-Kyu
SK
Rhim
Hyunchul
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001825:Body Fluid Compartments; D003937:Diagnosis, Differential; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D019512:Pancreatitis, Alcoholic / Q000000981:diagnostic imaging* / Q000473:pathology*; D012187:Retroperitoneal Space / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed