History of acute pancreatitis complicated by pseudocyst status post failed drainage at outside hospital. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. Normal postcontrast enhancement. Note is made of a hepatic cyst in segment 8. No intra or extrahepatic ductal dilatation. Normally distended gallbladder.SPLEEN: The spleen is normal morphology size and enhancement.PANCREAS: The pancreatic neck body and tail is replaced by a large complex loculated collection which extends superolaterally along the left pararenal space along the greater curvature of the stomach measuring 13.8 x 5.6 cm. It extends inferiorly along the right inferior anterior pararenal space into the lower abdomen adjacent to the psoas muscle where it consists of a multiloculated cystic collection measuring 6.0 x 5.3 cm. The larger left superolateral collection is markedly heterogeneous, contains layering T1 weighted hyperintense material posteriorly compatible with proteinaceous and or hemorrhagic products and centrally is very low on both T1 and T2-weighted sequences suggestive of air. The collection demonstrates peripheral thick-walled enhancement.More than 50% of the pancreatic parenchyma is replaced by this collection. The residual pancreatic head has a normal caliber main pancreatic duct and demonstrates normal postcontrast enhancement.The splenic vein is occluded.The very proximal portal vein/SMV portal vein confluence is nearly completely occluded by mass effect (series 1201/184). No arterial pseudoaneurysm is identified.Nondiagnostic secretin images.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See discussion above regarding peripancreatic fluid collection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Very large collection replacing the majority of the pancreatic parenchyma and extending in the retroperitoneum as described above demonstrating peripheral thick-walled enhancement and internal heterogeneity compatible with walled off necrosis with possibility of superinfection given the intrinsic T1 and T2-weighted hypointense signal intensity suggestive of air (versus chronic blood products), may also be post treatment gas within the collection.Splenic vein thrombosis. Near complete occlusion of the portal vein/SMV confluence.