History of pancreatic necrosectomy with high drain output. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size and signal intensity without a focal lesion.There is moderate dilatation of the common duct which measures up to 1.2 cm. Mild central intrahepatic biliary ductal dilatation. The common bile duct tapers smoothly at the level of the ampulla.The gallbladder has been surgically removed with a remnant cystic duct and cholecystectomy clips better seen on recent CT.In the gallbladder fossa there is a thick-walled heterogeneous predominantly T2-hyperintense fluid collection measuring 6.7 x 4.4 cm with regions of susceptibility artifact indicating air foci suggestive of superinfection.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates heterogeneous decreased intrinsic T1 weighted signal intensity. The parenchyma demonstrates postcontrast enhancement with focal parenchymal loss of the anterior pancreatic body compatible with necrosis. No specific evidence of hemorrhage.There is a peripancreatic fluid collection adjacent to the pancreatic tail measuring 4.4 x 2.3 cm (series 1 103/63) which is relatively in T2-weighted signal intensity. This communicates with a T2-weighted hyperintense peripherally thick-walled enhancing fluid collection extends along the left retroperitoneum along the pararenal space craniocaudally and involves the abdominal wall musculature inferiorly. There is a surgical drain in the inferior aspect of this collection.Adjacent to the inferior aspect of the pancreatic body is a 7.9 x 6.0 cm heterogeneous collection (image 68). This communicates with a more inferiorly located heterogeneous mesenteric collection measuring 6.3 x 2.6 cm (image 85). This communicates with an additional homogeneous fluid collection measuring 6.7 x 2.9 cm (image 86) anterior to the right pararenal fascia. There is a drainage catheter in the right pararenal space collection.The main pancreatic duct is mildly prominent at the tail with regions of focal narrowing at the pancreatic body measuring 2.1 cm in length (series 3/26 and series 6/92) and minimal narrowing at pancreatic head measuring approximate 7 mm in length (3/28 and series 6/112).No evidence of arterial pseudoaneurysm formation. There is moderate to severe narrowing of the SMV and splenic vein proximal to the portal vein confluence. The portal vein is patent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis. No hydronephrosis or focal lesion. Mild right perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion.
Multiple peripancreatic fluid collections are noted in the abdomen and retroperitoneum. The fluid collection in the gallbladder fossa is more homogeneously T2-hyperintense with gas foci more suggestive of a pseudocyst with possible super-infection. The bilateral pararenal space collections are more homogeneously T2-hyperintense suggestive of pseudocysts. The fluid collections adjacent to the pancreatic body and tail are more heterogeneous in signal intensity and are more suggestive of internal hemorrhage/proteinaceous products (i.e. walled-off-necrosis).Focal narrowing of the main pancreatic duct at the pancreatic body level. No evidence of parenchymal necrosis/hemorrhage.Moderate to severe narrowing of the SMV and splenic vein prior to the portal vein confluence. These were better opacified on the same day CT. 