Presentation
Acute onset of severe epigastric pain radiates to the back.
Patient Data
The pancreas is swollen with significant peripancreatic fat stranding extending to the right and left pararenal spaces with clear perirenal fat, giving bilateral renal halo sign, however, with relative hypo-enhancement in tail of the pancreas (in comparison with the rest of pancreatic parenchyma), representing acute pancreatitis with questionable pancreatic tail necrosis, which should be correlated with another study after 72 hours to rule out necrosis.
The splenic artery and portal veins are well opacified with contrast.
Mucosal hyperenhancement of the second and third part of the duodenum with surrounding fluid, suggesting reactionary changes.
Severe fatty liver infiltration is noted, with subcapsular fatty sparing areas.
No dense gallbladder stones.
The spleen, both suprarenal glands and both kidneys appear normal apart from small cyst in the lower pole of left kidney.
No abnormal bowel dilatation.
Mild abdominopelvic free fluid is noted.
No pneumoperitoneum.
Case Discussion
This patient was diagnosed with hypertriglyceridemia-induced acute pancreatitis.
His triglyceride level was 1878 mg/dl.
The liver also shows fatty infiltration which suggests high lipid profile.
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