Dr. Vivek Chail
General Practitioner
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Can you explain my CT scan results to me, especially regarding the information about the pancreas?
Clinical history: Diffuse abdominal pain.
Technique: Enhanced CT of abdomen and pelvis was using 100 cc of IV Omnipaque. 350 without oral contrast. Sagittal and coronal re-formations were provided. CT dose
Reduction: Automatic exposure control.
Comparision: None.
Finidngs: Clear lung bases. Visualized heart normal size.
Nonspecific mild periportal edema, the main portal vein is patent. The liver is otherwise unremarkable. The gallbladder is contracted. No intra or extrahepatic biliary ductal dilatation.
Indistinct peripancreatic soft tissue fat planes, edema versus insufficient intra-abdominal fat, correlate clinically for pancreatitis.
No abnormal parenchymal enhancement or ductal dilatation.
Spleen, adrenal glands, and left kidney within normal limits. Absent right kidney, possibly congenital without postop sequela. Decompressed urinary bladder. Prostate and seminal vesicles within normal limits.
No bowel obstruction or focal inflammatory changes. Appendix normal. Decompressed appearance of terminal ileum rather than mural thickening, however, limited. No ascites or fluid collection.
Normal osseous structures.
Initial preliminary interpretation was rendered by Teleradiology Solution services and is in slight discordance with final interpretation. Variance placed in PeerVue folder.
Impression: Correlate clinically for the remote possibility of pancreatitis, insufficient soft tissue fat planes for definitive evaluation of inflammation.
Hi,
Welcome to icliniq.com.
I hope you are not in much discomfort. The CT (computed tomography) abdomen and pelvis scan was done with contrast. Mild inflammatory changes are surrounding the pancreas. Also, there is a mention of gall bladder being contracted and mild periportal edema.
In the above findings, there can be a clinical possibility of mild acute pancreatitis, which might cause diffuse pain in the abdomen. Your doctors might ask for a blood test to check serum lipase and serum amylase levels.
Even if pancreatitis is confirmed in your blood tests, it is mild acute pancreatitis, and there is a good response to treatment in such cases.
Patient's Query
Thank you doctor,
I have been paranoid about cancer. Would this scan mostly rule that out, in your opinion?
Hi,
Welcome back to icliniq.com.
Your report does not mention any features of cancer of the pancreas. If you are a bit anxious about cancer of the pancreas, then I suggest getting a blood test for CA-19-9 levels. The levels of CA-19-9 are usually increased in cancer of the pancreas. However, please discuss with your doctors and get the test done.
Patient's Query
Thank you doctor,
Can you further explain what these two lines mean? No abnormal parenchymal enhancement or ductal dilatation and no intra or extrahepatic biliary ductal dilatation. And correlate clinically for the remote possibility of pancreatitis, insufficient soft tissue fat planes for definitive evaluation of inflammation (specifically what the word remote means). What does this mean?
Hi,
Welcome back to icliniq.com.
Abnormal parenchymal enhancement in the pancreas and pancreatic duct dilatation features mild to moderate abnormal conditions of the pancreas like pancreatitis or rarely even cancer pancreas. It is relieving to know that these features are not there in your can.
No intra or extrahepatic biliary ductal dilatation applies to the normal biliary tree inside the liver and outside. If there were any ductal dilatation, then it would mean obstruction to the flow of bile. Again it is a good sign that you do not have intra hepatic and extrahepatic biliary dilatation.
Pancreatitis is usually detected when there are moderate changes in the pancreas, and in your images, there are only mild changes. Therefore, the clinical correlation lines mean that you might need blood testing for serum amylase and serum lipase to confirm pancreatitis and match the CT abdomen and pelvis scan findings.
Patient's Query
Thank you doctor,
I appreciate your help. Would it be accurate to say that the CT scan shows possible inflammation around the pancreas but nothing in the actual organ? Or is that not clear based on reading? I am not sure what peripancreatic means. What exactly is a nonspecific mild periportal edema?
Hi,
Welcome back to icliniq.com.
You are right. There is inflammation surrounding the pancreas and not within the pancreas. Periportal edema is the mild inflammation of the portal venous radicals and a part of the liver's portal venous supply. The periportal edema is classified as nonspecific, meaning the cause for it is not established with certainty in the images.
Pancreatitis is a condition in which the pancreas can be completely normal on imaging in the mild stages, and therefore, a strong suspicion of pancreatitis is based on the surrounding findings of fat stranding as given in the report.
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General Practitioner
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