Preliminary Diagnosis: Pancreatic Abscess

I. What imaging technique is first-line for this diagnosis

  • CT scan of the abdomen and pelvis with po and intravenous contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic abscess.

Advantages
  • Highly sensitive and specific in detecting a primary abnormality, such as an abscess, and detecting and characterizing any secondary complications

  • May help guide treatment and therapy

  • Offers exquisite detail of the surrounding anatomical structures

Disadvantages
  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR of the abdomen and pelvis with IV contrast

  • Ultrasound

  • ERCP

  • MRCP.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic abscess.

MR of the abdomen and pelvis with IV contrast
Advantages
  • Does not expose patients to ionizing radiation

  • Offers exquisite detail of the surrounding soft tissues and helps characterize the extent of soft tissue invasion and extension

Disadvantages
  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Offers poor evaluation of the surrounding vascular and soft tissues

  • Less adept in guiding treatment

Ultrasound
Advantages
  • Highly portable imaging modality

  • May help guide percutaneous treatment and therapy

  • Offers exquisite visualization of any surrounding vascularity

Disadvantages
  • Less adept in detailing the surrounding anatomical structures

ERCP
Advantages
  • Offers the opportunity for simultaneous diagnostic evaluation and therapeutic treatment

  • May offer better anatomical detail of the pancreatic process and surrounding soft tissues

Disadvantages
  • Invasive procedure associated with greater morbidity and mortality

MRCP
Advantages
  • Offers exquisite anatomical detail of the intrahepatic and extrahepatic biliary tree and pancreatic ducts

  • Does not expose patients to ionizing radiation

Disadvantages
  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

MR of the abdomen and pelvis with IV contrast
  • Contraindicated in patients with non–MR-compatible hardware

Ultrasound
  • No specific contraindications exist.

ERCP
  • Contraindicated in patients with a severe hypocoagulable state

MRCP
  • Contraindicated in patients with non–MR-compatible hardware