Focal Necrotizing pancreatitis presenting as Page kidney
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Transcript of Focal Necrotizing pancreatitis presenting as Page kidney
FOCAL NECROTIZING PANCREATITIS PRESENTING AS
PAGE KIDNEY
Dr. Momin Mohammad AmerDr. Aniruddha KulkarniDr. Shubhangi Shetkar
Dr. Neeta Kadam
TAPADIA DIAGNOSTIC CENTRE, Aurangabad.Maharashtra.
CLINICAL HISTORY
• 25 year / male , chronic alcoholic
• Presented with pain in left hypogastric region• Recent onset of hypertension
• No h/o trauma
• Lab investigations - White blood cell count 11 900 × 109
C‐reactive protein 169 mg/l Serum amylase 120 U/l
Serum lipase 86 U/l
USG – Left perinephric anechoic collection causing distortion of left renal parenchyma
CECT abdomenLeft kidney : • distorted , displaced antero-superiorly
• large, sub-capsular, perinephric collection maximum depth of 95 mm
Post contrast coronal section
Left renal pelvis and vascular pedicle compressed
Delayed coronal Early sagittal
• Pancreatic tail bulky ~ 20 mm • Loss of acinar pattern, heterogeneous
post contrast enhancement
• Non enhancing, hypodense, necrotic areas within tail.
• Main pancreatic duct at tail region dilated ~ 7 mm
• Minimal peri-pancreatic fat stranding
• Head, uncinate process and body of pancreas unremarkable Curved MPR coronal section
Connection between sub-capsular collection and pancreatic tail necrosis
Curved MPR axial and sagittal
DIAGNOSIS - Focal necrotizing pancreatitis of tail resulting in left page kidney.
Page kidney - Phenomenon of hypertension that develops following long-standing compression of renal parenchyma by sub-capsular renal collection.
Compression of renal parenchyma
Compression of renal vessels
Decreased renal blood flow
Activation of Renin- angiotensin system
Rise in B.P. (Secondary hypertension)
REFERENCES Diagnostic Radiology, A Textbook of Medical Imaging Grainger
and Allison's 4t edition, Vol. 2, P.No. 1088, 1303-04. Chowdhury P, Gupta P. Pathophysiology of alcoholic
pancreatitis: An overview. World J Gastroenterol 2006;12:7421-7
Diagnostic ultrasound, IInd Edition Vol. One P.No. 199-202. Carol M. Rumack/Stephenic R. Wilson, J. William Charbonean
Balthazar EJ, Fisher LA. Frey C. Hemorrhagic complication of pancreatitis: radiological evaluation with emphasis on CT Imaging. Pancreatology 2001;1(4): 3006-3013