Necrotizing pancreatitis with fat necrosis: The radiologist’s point of view
Keywords:
Pancreatitis, necrotizing, fat necrosis, imagingAbstract
Learning Objectives: This pictorial review aims to highlight the pathology and clinical features of fat necrotizing pancreatitis, as well as to review its classification and imaging findings by analyzing recent cases from our experience.
Background: Pancreatitis is an inflammatory condition that often involves a complex pathological response. In necrotizing pancreatitis, both pancreatic and peripancreatic tissues may be affected, leading to high morbidity and mortality. Fat necrosis, a significant complication of severe pancreatitis, is characterized by saponification of peripancreatic fat. Recognizing the diagnostic challenges and imaging findings related to pancreatitis-induced fat necrosis is crucial for healthcare professionals and treatment planning. In the early phase of the disease, imaging (CT or MRI) is essential for diagnosing fat necrosis, particularly when the patient's condition fails to improve or worsens. Additionally, late-stage imaging is critical for identifying complications and for follow-up.
Findings: We present a series of 10 cases of necrotizing pancreatitis from a single center over a two-year period, from December 2021 to March 2024. All scans were performed using a 320-detector row, 640-slice CT scanner, with intravenous contrast administered—either with a pancreatic protocol or during the portal phase, depending on the clinical question. We will highlight the key CT radiological features indicative of fat necrosis, such as linear stranding, hyperattenuation, heterogeneous peripancreatic fat, and encapsulated collections. Additionally, we will present two cases in which complications of fat necrotizing pancreatitis, such as peripancreatic abscesses, were managed with CT-guided drainage.
Conclusion: Pancreatitis with fat necrosis presents significant diagnostic and management challenges. Early identification of the pathology through imaging and timely medical or surgical intervention can prevent severe complications.
