Pancreatitis Clinical Pathway, Emergency Department and Inpatient – Imaging

Pancreatitis Clinical Pathway — Emergency Department and Inpatient

Imaging

Ultrasound Right
Upper Quadrant
  • First-line, non-invasive imaging modality in children < 100 kg with suspected AP
    • Modality of choice for assessing pancreatic parenchyma
    • Can assess liver, gallbladder, pancreas, spleen, and abdominal cavity for ascites
    • Modality of choice for diagnosing gallstones
  • Limitations
    • Negative ultrasound does not exclude AP (low to moderate sensitivity)
    • May not visualize entire pancreas due to overlying bowel gas
    • May not visualize pancreas clearly in children with obesity
    • Exam may be limited by pain
  • Consider ultrasound with Doppler if suspicion of thrombosis or portal hypertension

Advanced Imaging after Complete Abdominal Ultrasound

Consider Epic Chat to PHL Radiology Ultrasound to discuss further imaging.

Pancreas Ultrasound Non-invasive method to follow up pancreatic inflammation or fluid collections
CT Abdomen and Pelvis
with IV Contrast
  • Preferred modality in known or suspected AP for:
    • Clinical instability
    • Abdominal trauma
    • ≥ 100 kg in whom ultrasound not as sensitive
    • Diagnosis of necrotizing pancreatitis, especially with oncologic process
  • Limitations
    • May underestimate the complexity of fluid collections
    • Requires IV, radiation exposure
Magnetic Resonance Cholangiopancreatography (MRCP)
  • Preferred modality in known/suspected AP for:
    • Diagnosing autoimmune pancreatitis
    • Evaluating for ductal abnormalities/obstructive causes of pancreatitis
    • Characterizing peripancreatic fluid collections prior to intervention
  • Limitations
    • May require sedation in younger children
    • May be limited by pain due to length of exam
  • In between episodes of AP, may be performed with secretin administration to clarify ductal anatomy and estimate exocrine function. Secretin is contraindicated in episodes of AP.
Contrast-Enhanced Ultrasound (CEUS)
  • Useful in diagnosing necrotizing pancreatitis if CT cannot be performed
  • May be performed at the bedside in critically ill children
  • Requires IV