Pediatric Pancreatitis

Acute pancreatitis

  • Etiology: stones in gallbladder / common bile duct / pancreatic duct, congenital duct anomalies – pancreatic divisum / long common channel, viral (mumps, coxsackie, CMV, EBV), medications, blunt abdominal trauma,idiopathic
  • Imaging: parenchymal findings – focal / diffuse enlargement of pancreas with heterogenous enhancement / pancreatic necrosis (decreased density, enhancement) / abnormal parenchymal signal [normally pancreas is hyperintense to liver on T1WI and isointense to liver on T2WI], peripancreatic inflammation, peripancreatic fluid, necrosis (pancreatic / peripancreatic), vascular thrombosis / pseudoaneurysm, pseudocyst (simple fluid, well defined wall), walled off necrosis is pancreatic or peripancreatic and contains debris / solid components
  • Complications: necrosis of pancreas, peripancreatic fluid, vascular thrombosis / pseudoaneurysm, infection (gas in tissue)
  • Clinical: abdominal pain, amylase + lipase 3 times normal, complete structural + functional reconstitution of pancreas at end

Acute recurrent pancreatitis

  • Etiology: idiopathic, structural anomalies, genetic / heriditary
  • Imaging: findings are same as acute pancreatitis but look for bilio-pancreatic structural + obstructive causes

Chronic pancreatitis

  • Definition: > 2 episodes of acute pancreatitis that return to baseline
  • Etiology: cystic fibrosis, fibrosing pancreatitis, heriditary chronic pancreatitis, inborn errors of metabolism
  • Imaging: main pancreatic duct dilation and irregularity, side pancreatic duct dilation, pancreatic duct strictures, pancreas loss of T1 signal and delayed enhancement, pancreas fibrosis and atrophy, calcification
  • Clinical: severe chronic abdominal pain, exocrine pancreatic insufficiency, glycemic abnormalities, diabetes

Radiology Cases of Acute Pancreatitis

Radiology Cases of Chronic Pancreatitis

AXR of cystic fibrosis with pancreatic insufficiency
AXR shows calcifications throughout the pancreas.
US of pancreatitis caused by pancreatic duct stone
Transverse US of the pancreatic head (above) shows just to the right of midline a round echogenic lesion with posterior shadowing in the center of the pancreatic head while transverse US of the pancreatic body (below) shows a dilated pancreatic duct throughout the body of the pancreas.