Papel de la imagen en el diagnóstico de la pancreatitis crónica / Role of imaging in the diagnosis of chronic pancreatitis

La pancreatitis crónica es un proceso fibroinflamatorio progresivo del páncreas que produce un daño estructural permanente y condiciona un deterioro de la función exocrina y endocrina. La aparición de brotes de pancreatitis aguda, seudoquistes y masas inflamatorias forman parte de la historia de la enfermedad. Otras complicaciones son vasculares, digestivas o el riesgo aumentado de adenocarcinoma pancreático. Por todo ello, se requiere de pruebas diagnósticas capaces de detectarla, especialmente en las etapas iniciales de la enfermedad. Se propone un algoritmo diagnóstico que debe progresar desde técnicas no invasivas a procedimientos invasivos. La tomografía computarizada descarta otras causas de dolor abdominal e identifica complicaciones de la pancreatitis. La colangiografía por resonancia magnética puede ser la prueba de elección, ya que permite la evaluación de los cambios ductales y posiblemente evita la necesidad de una colangiopancreatografía retrógrada endoscópica. Cuando las pruebas de imagen son normales y persiste la sospecha clínica, deben considerarse las pruebas de función pancreática o una ecoendoscopia

Chronic pancreatitis is a progressive fibroinflammatory process in the pancreas that causes permanent structural damage and leads to a deterioration in exocrine and endocrine function. The appearance of flares of acute pancreatitis, pseudocysts, and inflammatory masses all form part of the natural history of this disease. Vascular and / or digestive complications may occur, and patients with chronic pancreatitis have an increased risk of pancreatic adenocarcinoma. For all these reasons, diagnostic tests that can detect chronic pancreatitis are necessary, especially in the early stages of the disease. We propose a diagnostic algorithm that should progress from noninvasive techniques to invasive procedures. Computed tomography can rule out other causes of abdominal pain and identify complications of pancreatitis. Magnetic resonance cholangiography can be the method of choice because it enables changes in the ducts to be assessed and might obviate the need for endoscopic retrograde cholangiopancreatography. When the findings on imaging tests are normal but clinical suspicion persists, pancreatic function tests or endoscopic ultrasound should be considered

Linfografía intranodal en el tratamiento de la ascitis quilosa / Intranodal lymphangiography in the treatment of chylous ascites

La ascitis quilosa es la presencia de linfa de origen torácico o intestinal en la cavidad abdominal. Las causas más comunes en adultos en países occidentales son la patología tumoral, la cirrosis y las posquirúrgicas, mientras que en niños lo son las anomalías linfáticas congénitas y las traumáticas. Por el contrario, las etiologías infecciosas son responsables de la mayoría de los casos en los países en vías de desarrollo. Presentamos un caso de ascitis quilosa secundaria a pancreatitis aguda necrotizante, resistente a medidas conservadoras, que se resolvió de forma definitiva tras la realización de una linfografía intranodal con lipiodol. Se trata de una técnica segura, eficaz y mínimamente invasiva en la detección y tratamiento de fugas linfáticas

Chylous ascites is the presence of lymph from the thorax or bowel in the abdominal cavity. In Western countries, the most common causes of chylous ascites in adults are tumors, cirrhosis, and postoperative leakage, whereas the most common causes in children are congenital lymphatic anomalies and trauma. By contrast, in developing countries, infectious causes are responsible for most cases of chylous ascites. We present a case of chylous ascites secondary to acute necrotizing pancreatitis refractory to conservative treatment that was definitively resolved after intranodal lymphangiography with lipiodol. This is a safe and efficacious minimally invasive treatment for lymphatic leakage

Role of imaging in the diagnosis of chronic pancreatitis. / Papel de la imagen en el diagnóstico de la pancreatitis crónica.

Chronic pancreatitis is a progressive fibroinflammatory process in the pancreas that causes permanent structural damage and leads to a deterioration in exocrine and endocrine function. The appearance of flares of acute pancreatitis, pseudocysts, and inflammatory masses all form part of the natural history of this disease. Vascular and / or digestive complications may occur, and patients with chronic pancreatitis have an increased risk of pancreatic adenocarcinoma. For all these reasons, diagnostic tests that can detect chronic pancreatitis are necessary, especially in the early stages of the disease. We propose a diagnostic algorithm that should progress from noninvasive techniques to invasive procedures. Computed tomography can rule out other causes of abdominal pain and identify complications of pancreatitis. Magnetic resonance cholangiography can be the method of choice because it enables changes in the ducts to be assessed and might obviate the need for endoscopic retrograde cholangiopancreatography. When the findings on imaging tests are normal but clinical suspicion persists, pancreatic function tests or endoscopic ultrasound should be considered.

Intranodal lymphangiography in the treatment of chylous ascites. / Linfografía intranodal en el tratamiento de la ascitis quilosa.

Chylous ascites is the presence of lymph from the thorax or bowel in the abdominal cavity. In Western countries, the most common causes of chylous ascites in adults are tumors, cirrhosis, and postoperative leakage, whereas the most common causes in children are congenital lymphatic anomalies and trauma. By contrast, in developing countries, infectious causes are responsible for most cases of chylous ascites. We present a case of chylous ascites secondary to acute necrotizing pancreatitis refractory to conservative treatment that was definitively resolved after intranodal lymphangiography with lipiodol. This is a safe and efficacious minimally invasive treatment for lymphatic leakage.

Utilidad del diagnóstico por la imagen en el mielolipoma extraadrenal / Utility of diagnostic imaging in the diagnosis of extra adrenal myelolipoma

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