Posted on May 15, 2019


of acute pancreatitis was derived over 20 years ago.1 It attempted to provide a common termi‑ nology and to define the severity of the disease. The Revised Atlanta classification of acute pancreatitis is an international multidisciplinary classification of It was initially revised in and then further updat. The. “acute pancreatitis – Rating: Review Atlanta classification and definitions for international consensus” tries to O critério de diagnóstico radiológico.

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However there is a need to study the role of other imaging modalities especially in selecting management options.

Furthermore, a discrimination was made between two clinical phases of pancreatitis: On the upper image is a collection in the area of the pancreatic head in the right anterior pararenal space. Intraabdominal fluid collections and collections of necrotic tissue are common in acute pancreatitis.

These images are of a patient who presented with acute severe epigastric pain very suggestive of acute pancreatitis. The Atlanta Classification of acute pancreatitis revisited.

The CT shows a similar collection of fluid density to that of the patient with the pseudocyst, except for its pancreatic location. Log in Sign up. Based on CT alone it is sometimes impossible to determine whether a collection contains fluid only or a mixture of fluid and necrotic tissue. Necrosis can be diagnosed with MRI, which of course should only be performed if it has direct clinical implications.

They also noted that patients with widespread EXPN had appreciably higher frequency of pleural effusion, ascites and multi-organ failure, but similar outcome as patients with limited EXPN. As more data emerge and the complexities of the spectrum of acute pancreatitis unfold, key concepts are likely to get revised. The RAC has recognized EXPN as an important component of morphology but has not taken into account its impact on course of the disease. Systematic appraisal of the management of the major vascular complications of pancreatitis.


The retroperitoneal approach has some advantages: Usually occurs in the 2nd-4th week and rarely in the first week.

Mild – No organ criteerios and no local or systemic complications. Other studies have also supported the contention that IN affects survival and occurrence of OF [ 20 – 23 ].

The Radiology Assistant : Pancreas – Acute Pancreatitis

An assessment of the severity of interstitial pancreatitis. The term pancreatic abcess is no longer used, since a collection of pus without necrotic tissue is extremely uncommon in acute pancreatitis.

Fistulization in the GI tract in acute pancreatitis. It is characterized by a protracted clinical course, a high incidence of local complications, and a high mortality rate. They however suggested that patients with EXPN need extra consideration during necrosectomy to avoid iatrogenic pancreatic injury. The images show spontaneous regression of an acute peripancreatic fluid collection APFC. A pseudocyst requires 4 or more weeks to develop.

There is emerging data on the role of EUS to differentiate the amount of solid necrotic debris in the collection having management implications. Continue with the next image.

The table summarizes the CT criteria for pancreatic and peripancreatic fluid collections in acute pancreatitis.

The importance of EPIs and their effect on the outcome pancdeatitis AP have been highlighted by various studies. Most often, they occur in the lesser sac.

We in a prospective study also found that the number of EPIs was significantly higher than pancreatic infections with no association between the presence of the two infections [ 47 ].

They are seen within 4 weeks in interstitial 2021. Acute oedematous or interstitial pancreatitis. They also reported that in patients with pancreatic parenchymal necrosis, bacteremia was associated with increased risk of IN and was associated with higher mortality. This case is a typical example of infected pancreatic necrosis.

Organ failure and infection of pancreatic necrosis criterioss determinants of mortality in patients with acute pancreatitis. Eur J Surg ; Many of these patients however re have necrotizing pancreatitis and the mortality increases when the necrosis becomes infected. Infection of necrotic pancreatic parenchyma or extrapancreatic fatty tissue – i. The revised Atlanta classification for acute pancreatitis: Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week.


The CT-image shows a homogeneous peripancreatic collection in the transverse mesocolon arrow. Not transgastric route for diagnosis only. However with application of the RAC into clinical practice, its limitations had started to get recognized.

The body and tail of the pancreas do not enhance.

The Revised Atlanta Classification of Acute Pancreatitis: A Work Still in Progress?

This area also needs further prospective evaluation. On day 3 there is no enhancement of the pancreas, consistent with necrosis. Response to Talukdar and Vege. Necrosis of the pancreas Inhomogeneous collection in the peripancreatic tissue No wall We can conclude that this is an acute necrotic collection – ANC. As we have recently shown that infection of fluid collections can be diagnosed non-invasively using labeled leucocytes and Positron Emission Tomography [ 79 ], and recently diffusion-weighted magnetic resonance imaging DWMRI has been used in the detection of infection in fluid collections [ 80 ].

While a majority of the extra pancreatic complications have been included in RAC [ 4 ], a few that may have important bearing on the outcome of AP have not been considered. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis.

Thus there is a need to distinguish infected from non-infected necrosis. There is always a scope to enhance the functionality besides the practicality of a classification; with the various advancements in all fields encompassing this illness amendments are mandated in due course of time.