Air within a pancreatic inflammatory mass: not necessarily a sign of abscess

Intrapancreatic air is considered to be a reliable if not a diagnostic sign of pancreatic abscess. The presence of extraluminal air within the pancreatic bed may also result from perforation of a pseudocyst into adjacent bowel. We describe a patient believed to have a pancreatic phlegmon both clinically and radiographically, in whom intrapancreatic air could be demonstrated on multiple abdominal CT scans over several months. The relatively unremarkable clinical course of this patient during an 11-month interval is incompatible with the usual rapid deterioration and high mortality rate of untreated pancreatic abscess.