Ultrasonography, computed tomography and percutaneous intervention in acute pancreatitis: a serial study

Fifty-seven patients (45 males, 12 females) with a clinical diagnosis of acute pancreatitis were serially evaluated by ultrasonography (US) and computed tomography (CT). Thirty patients had a single study, 18 had one follow-up study while 9 had two follow-up studies. The aetiology was gallstone disease in 26% of patients and a history of chronic alcohol abuse in only 16%. No cause could be identified in 47% of patients; 22% of US scans were unsatisfactory for the evaluation of pancreas whereas CT was uniformly satisfactory. Peripancreatic inflammation was detected in only 29% patients on US compared with 91% on CT. Pancreatic abscesses were detected in 8 patients on CT and gas was present in all of them. Fourteen patients underwent guided interventional procedures (US, 12; CT, 2). On follow up after 3 months, worsening of inflammation was detected in 11% patients on CT, which was not detected on US. It is concluded from this study that CT is far superior to US in the evaluation of acute pancreatitis, detection of peripancreatic inflammation and its extension into the retroperitoneal compartments and mesentery, and also for the evaluation of fluid collections, haemorrhage and abscesses. However, US provides easy guidance for percutaneous interventional procedures and can be used for follow-up scans.