hemorrhagic pancreatitis

Hemorrhagic pancreatitis is characterized by bleeding within or around the pancreas, and is usually considered a late sequela of acute pancreatitis.

Pathology

Hemorrhage can occur in patients with severe necrotizing pancreatitis or as a result of pancreatic pseudoaneurysm rupture when it constitutes a life-threatening emergency.

Etiology

According to one study, the usual causes of hemorrhage were :

  • bleeding pancreatic pseudoaneurysm or peripancreatic pseudoaneurysm: ~60%
  • diffuse bleeding with pancreatic necrosis: ~20%
  • hemorrhagic pancreatic pseudocysts: ~20%

Radiographic features

CT

Acute hemorrhage typically has high attenuation on unenhanced CT scans. The attenuation value then decreases as the hematoma ages through time .

MRI

Hemorrhagic fluid collections are more evident on MRI than CT due to the following reasons :

  • T1: high-signal intensity methemoglobin 
  • T2: low-signal intensity hemosiderin rim

Signal abnormalities due to hemorrhage remain visible longer on MRI than on CT.

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