Walled-off pancreatic necrosis and other current concepts in the radiological assessment of acute pancreatitis.
Acute pancreatitis is an inflammatory condition caused by intracellular activation and extravasation of inappropriate proteolytic enzymes determining destruction of pancreatic parenchyma and peripancreatic tissues. This is a fairly common clinical condition with two main presentations, namely, endematous pancreatitis - a less severe presentation -, and necrotizing pancreatitis - the most severe presentation that affects a significant part of patients. The radiological evaluation, particularly by computed tomography, plays a fundamental role in the definition of the management of severe cases, especially regarding the characterization of local complications with implications in the prognosis and in the definition of the therapeutic approach. New concepts include the subdivision of necrotizing pancreatitis into the following presentations: pancreatic parenchymal necrosis with concomitant peripancreatic tissue necrosis, and necrosis restricted to peripancreatic tissues. Moreover, there was a systematization of the terms acute peripancreatic fluid collection, pseudocyst, post-necrotic pancreatic/peripancreatic fluid collections and walled-off pancreatic necrosis. The knowledge about such terms is extremely relevant to standardize the terminology utilized by specialists involved in the diagnosis and treatment of these patients.
MD, Radiologist, Image Memorial/DASA and Diagnoson a+ Medicina Diagnóstica, Salvador, BA, Brasil.
Elen Freitas de Cerqueira
EF
Cunha
Private Docent, Associate Professor, Department of Radiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
Manoel de Souza
Mde S
Rocha
MD, Radiologist, Instituto de Radiologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brasil.
Fábio Payão
FP
Pereira
PhDs, MDs, Radiologists, Instituto de Radiologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
Roberto
R
Blasbalg
PhDs, MDs, Radiologists, Instituto de Radiologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
Ronaldo Hueb
RH
Baroni
Pancreatitis; Pseudocyst; Walled-off pancreatic necrosis