Revised Atlanta Classification of Acute Pancreatitis The table summarizes the CT criteria for pancreatic and peripancreatic fluid The CT severity index (CTSI) combines the Balthazar grade ( points) with the extent. Em , Balthazar et al. Critérios subjetivos foram utilizados para definir a diferenciação entre líquido coletado e líquido livre inflamatório, uma vez que. The BISAP Score for Pancreatitis Mortality predicts mortality risk in pancreatitis with fewer variables than Ranson’s.

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An important consideration was the impossibility to correlate the tomographic finds with the serum concentration of reactive C proteins, which is considered until the present moment the best prognosis indicator of AP.

Balthazar D or E, without pancreatic necrosis; peripancreatic collections are due to extrapancreatic necrosis severe pancreatitis necrotising: Support Radiopaedia and see fewer ads. The CT-image shows a homogeneous peripancreatic collection in the transverse mesocolon arrow.

All these collections may remain sterile or become infected. Scroll through the images.

The patient did not have fever. The principal investigators of the study request that you use the official version of the modified score here. No pancreatitks with intestinal flora. On the day of admission, scoring systems based on imaging do not outperform scoring systems based on clinical and biochemical parameters with regard to predicting clinical outcome.

Rev Esp Enferm Dig ; The characteristics of the patients that were included on the study galthazar shown on table I. Two weeks later there are gas bubbles in the peripancreatic collection consistent with an infected acute necrotic collection.

Communication with the pancreatic duct may be present. As the patient’s condition worsened, a second CT was performed on day 3. Serum lipase or amylase activity at least three times greater than the upper limit of normal.


In the early stage, such a collection does not have a wall or capsule. Frequently they regress spontaneously. Balthazar E Case 4: American College of Gastroenterology guideline: Acute oedematous or interstitial pancreatitis.

Central gland necrosis Central gland necrosis is a specific form of necrotizing pancreatitis, representing full thickness necrosis between the pancreatic head and tail and is nearly always associated with disruption of the pancreatic pnacreatitis.

On day 18 an incomplete wall is present, but we can assume that in a couple of days this will be a walled-of-necrosis with a complete wall. Med Intensiva ; Early severity stratification of acute pancreatitis is important to identify patients with the highest morbidity. Valthazar of Acute Pancreatitis The diagnosis of acute pancreatitis requires two of the following three features: Here a patient with several homogeneous peripancreatic collections on CT.

Loading Stack – 0 images remaining. Balthazar B or C, without pancreatic or extrapancreatic necrosis intermediate exudative pancreatitis: In order to make the correlation, the Pearson or the Spearman tests were used according to the distribution of the variables. Unable to process the form.

Most of the pancreas is normal. There were included patients of any gender above the age of 18, with diagnosis of acute pancreatitis of any etiology, balthazwr had performed an abdominal tomography 72 hours after the beginning of the clinical condition in order to stage the pancreatic damage.

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Pancreas – Acute Pancreatitis 2.0

Mild – No organ failure and no local or systemic complications. These collections also show homogeneous high signal intensity on a fat-suppressed T2-weighted MRI image, are fully encapsulated and contain clear fluid i.

Take home messages Be familiar with the terminology in acute pancreatitis using the Revised Atlanta Classification.


The CT severity index CTSI combines the Balthazar grade points with the extent of pancreatic necrosis points on a point severity scale. Rev Med Int Med Crit ; 1: Introduction The acute pancreatitis AP keeps on being one of the gastrointestinal pathologies with more incidence and that can unchain praa significative mortality.

Reproducibility in the assessment of acute pancreatitis with computed tomography

The patient became septic and a percutaneous drainage was performed. This maybe explained because it is a third level concentration center in which most of the AP patients are looked after in second level centers, therefore our results cannot be extrapolated to the population paara general; it would be important baltazar perform this analysis on these kind of attention centers.

The Revised Atlanta Classification discerns 4 types of peripancreatic fluid collections in acute pancreatitis depending on the content, degree of encapsulation and time.

There are 3 subtypes of necrotizing pancreatitis: It takes about 4 weeks for a capsule to form. Prognostic indicators in acute pancreatitis: Preferred locations of fluid collections are:.

The Radiology Assistant : Pancreas – Acute Pancreatitis

Here we see a homogeneous pancreatic and peripancreatic collection, well demarcated with an enhancing wall, on day 25 of an episode of acute necrotizing pancreatitis. Log in Sign up. Since the diagnosis of acute pancreatitis is usually made on clinical and laboratory findings, an early CT is only recommended when the diagnosis is uncertain, or in case of suspected early complications pancreatutis as bowel perforation or ischemia.