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21
O iginal Resea ch A icle
Role o USG and Con as Enhanced Compu ed Tomog aphy in Diagnosis
o he Local Complica ions o Acu e Panc ea i is
S ijak Bha acha ya1, Supa na Sahu2, Malay Ka maka 3
1Senio Residen , MD, Radio Diagnosis, Depa men o Radio-Diagnosis, Nil Ra an Sa ka Medical
College and Hospi al, Kolka a, Wes Bengal 700014
2Senio Residen , MD, Radio Diagnosis, Depa men o Radio-Diagnosis, Nil Ra an Sa ka Medical
College and Hospi al, Kolka a, Wes Bengal 700014
3Associa e P o esso , MD, Radio Diagnosis, Depa men o Radio-Diagnosis, Nil Ra an Sa ka Medical
College and Hospi al, Kolka a, Wes Bengal 700014
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 27-08-2025
Co esponding Au ho : D . Supa na Sahu
Con lic o in e es : Nil
Abs ac
In oduc ion: Acu e panc ea i is (AP) is a common gas oin es inal eme gency, o en complica ed by local
mani es a ions such as panc ea ic nec osis, pseudocys s, luid collec ions, and abscesses. Timely and accu a e
de ec ion o hese complica ions is c ucial o pa ien managemen and p ognosis. Imaging modali ies such as
ul asonog aphy (USG) and con as -enhanced compu ed omog aphy (CECT) play a pi o al ole in diagnosis.
Aims: To e alua e and compa e he e ec i eness o USG and CECT in iden i ying he local complica ions o
acu e panc ea i is.
Ma e ials and Me hods: The p esen s udy is a c oss-sec ional s udy conduc ed a he Depa men o
Radiodiagnosis, Nil Ra an Si ca Medical College, Kolka a, om Janua y 2020 o June 2021. I included a o al
o 50 middle-aged pa ien s wi h clinically suspec ed o biochemically/ adiologically con i med acu e
panc ea i is, who we e e e ed o abdominal ul asonog aphy (USG) and con as -enhanced compu ed
omog aphy (CECT) om he eme gency o ou pa ien depa men s. USG and CECT we e pe o med on all
pa ien s, and he indings we e eco ded in a p e-designed p o o ma and subsequen ly analyzed using
app op ia e s a is ical me hods.
Resul s: In ou s udy o 50 acu e panc ea i is pa ien s, USG showed panc ea ic enla gemen (head 30%, body
30%, ail 24%), he e ogeneous echo ex u e (72%), pe ipanc ea ic collec ions (54%), pseudo cys s (26%),
walled-o nec osis (8%), and po al ein h ombus (6%). CECT de ec ed pe ipanc ea ic a s anding (88%),
panc ea ic enla gemen (head 46%, body 58%, ail 48%), luid collec ions, pseudo cys s (28–30%), walled-o
nec osis (6–12%), and enous h ombosis (po al 12%, splenic 4%). O e all, CT was supe io in de ec ing
panc ea ic enla gemen , localizing pseudo cys s, nec osisand iden i ying enous h ombosis o o he ascula
complica ion.
Conclusion: While USG emains a use ul ini ial, non-in asi e, bedside ool o sc eening local complica ions o
acu e panc ea i is, CECT is he imaging modali y o choice o comp ehensi e e alua ion, accu a e diagnosis,
and guiding he apeu ic decisions. In eg a ion o bo h modali ies enhances diagnos ic con idence and op imizes
pa ien ca e.
Keywo ds: Acu e panc ea i is, Ul asonog aphy, Con as -enhanced compu ed omog aphy, panc ea ic nec osis,
Pseudocys , Pe ipanc ea ic luid collec ions.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Acu e panc ea i is (AP) is a common and
po en ially li e- h ea ening condi ion cha ac e ized
by in lamma ion o he panc eas, o en leading o
local complica ions such as panc ea ic nec osis,
pseudocys s, abscesses, and pe ipanc ea ic luid
collec ions [1,2]. Timely and accu a e diagnosis o
hese complica ions is c ucial o e ec i e
managemen and imp o ed pa ien ou comes [3].
Imaging modali ies play a pi o al ole in he
assessmen o AP and i s complica ions [4].
Ul asonog aphy (USG) is a widely a ailable, non-
in asi e imaging echnique ha se es as an ini ial
diagnos ic ool o de ec ing galls ones and
assessing panc ea ic mo phology [5,6]. Howe e ,
i s u ili y is limi ed by ac o s such as bowel gas
in e e ence, obesi y, and ope a o dependency,
which can hinde isualiza ion o he panc eas and
pe ipanc ea ic s uc u es [7]. Con as -enhanced
compu ed omog aphy (CECT) has eme ged as he
gold s anda d o e alua ing he se e i y and ex en
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Bha acha ya e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
22
o acu e panc ea i is and i s local complica ions
[8,9]. CECT p o ides de ailed ana omical
in o ma ion, allowing o accu a e assessmen o
panc ea ic nec osis, luid collec ions, pseudo cys s,
and abscesses, he eby guiding he apeu ic
decision-making [10]. The gene al objec i e o he
s udy is o e alua e and compa e he ole o
con as -enhanced compu ed omog aphy (CECT)
and ul asonog aphy (USG) in de ec ing
complica ions o acu e panc ea i is. Speci ically,
he s udy aims o assess he diagnos ic accu acy,
sensi i i y, and speci ici y o USG and CECT in
iden i ying and e alua ing he local complica ions
associa ed wi h acu e panc ea i is.
Ma e ials and Me hods
S udy Type: C oss sec ional based s udy
S udy Place: Depa men o Radio- Diagnosis, Nil
a an Si ca Medical College, Kolka a.
S udy Du a ion: 1.5 yea s (Janua y 2020 o June
2021)
S udy Popula ion: Pa ien s e e ed o abdominal
ul asonog aphy and con as enhanced CT o he
Depa men o Radiodiagnosis, Nil Ra an Si ca
Medical College and hospi al wi h clinical
suspicion o acu e panc ea i is, al e ed biochemical
pa ame e s (se um amylase and lipase) in a ou o
acu e panc ea i is, ul asonog aphy sugges i e o
acu e panc ea i is o i s complica ions in adul
pa ien s a ending eme gency o ge ing admi ed
om a ious clinical ou doo s du ing Janua y 2020
o June 2021.
Sample Size: 50 pa ien s diagnosed wi h acu e
panc ea i is
Inclusion C i e ia
• Age: 20 – 50 yea s
• Gende : Male and Female
• All he pa ien s who a e suspec ed o acu e
panc ea i is based on clinical and labo a o y
indings
• Pa ien s al eady diagnosed as ha ing acu e
panc ea i is on p e ious adiological
in es iga ion
Exclusion C i e ia
• Congeni al panc ea ic lesions
• Panc ea ic ca cinoma and me as asis
• T auma ic inju y o he panc eas
• Simple cys o he panc eas
• P egnancy
• Ele a ed se um c ea inine le el (>1.5mg/dl)
S udy Va iables
• USG indings
• CT indings
• Ou pu
S a is ical Analysis: Da a om he s udy we e
analyzed using SPSS so wa e, wi h con inuous
a iables (e.g., age, li e enzyme le els) exp essed
as mean ± SD and compa ed using - es s o Mann–
Whi ney U es s.
Ca ego ical a iables (e.g., gende , CBD s ones,
and complica ions) we e p esen ed as equencies
and pe cen ages, and compa ed using Chi-squa e o
Fishe ’s exac es s. Diagnos ic accu acy
(sensi i i y, speci ici y, PPV, NPV, and accu acy)
was calcula ed o MRCP- i s and EUS- i s
s a egies, using ERCP/in aope a i e indings as
he e e ence. Kaplan-Meie analysis may be used
o ime- o-in e en ion compa isons. A p- alue <
0.05 was conside ed signi ican .
Resul
Table 1: Dis ibu ion o he USG indings
USG indings
Yes
No
N
%
N
%
Bulky
Head
15
30
35
70
Body
15
30
35
70
Tail
12
24
38
76
Collec ion
Pe ipanc ea ic
25
50
25
50
Pe i enal
6
12
44
88
Th ombus
Po al ein
3
6
47
94
Splenic ein
0
0
50
100
Hypoechoic
17
34
33
66
He e ogenous echo
36
72
14
28
GB/CBD Calci ica ion
15
30
35
70
Dila ed MPD
6
12
44
88
Pleu al e usion
9
18
41
82
Pseudocys
13
26
37
74
Walled - o Nec osis
4
8
46
92
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Table 2: Dis ibu ion o he CT indings
CT indings
Yes
No
N
%
N
%
Panc ea ic enla gemen
Head
23
46
27
54
Body
29
58
21
42
Tail
24
48
26
52
Acu e luid collec ions
Head
11
22
39
78
Body
13
26
37
74
Tail
14
28
36
72
Pe i enal
14
28
36
72
Pa acolic/P el ic
14
28
36
72
Pleu al e usion
9
18
41
82
Pseudocys
Head
13
26
37
74
Body
15
30
35
70
Tail
15
30
35
70
Acu e nec o ic collec ions
Head
3
6
47
94
Body
5
10
45
90
Tail
8
16
42
84
Pe i enal
5
10
45
90
Pa acolic/Pel ic
5
10
45
90
Walled - o Nec osis
Head
3
6
47
94
Body
6
12
44
88
Tail
3
6
47
94
Venous h ombosis
Po al ein
6
12
44
88
Splenic ein
2
4
48
96
Pe ipanc ea ic a s anding
44
88
6
12
Pseudoaneu ysm
0
0
50
100
Haemo hage
0
0
50
100
Table 3: Compa ison o he ou pu s be ween USG and CT
Ou pu s
USG
CT
X² alue
P alue
Enla gemen
Yes
28.00%
50.70%
10.795
0.001
No
72.00%
49.30%
Pseudocys
Yes
26.00%
28.70%
0.183
0.668
No
74.00%
71.30%
Wald o nec osis
Yes
8.00%
8.00%
NA
NA
No
92.00%
92.00%
Venous Th ombosis
Yes
3.00%
8.00%
4.229
0.034
No
97.00%
92.00%
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Figu e 1: Dis ibu ion o he USG indings
Figu e 2: Compa ison o he ou pu s be ween USG and CT
USG o Pseudocys in he pe ipanc ea ic egion
Collec ion in bo h pe i enal space
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Pseudocys in ela ion o he body o panc eas
Acu e Nec o ic collec ion
Splenic ein Th ombus wi h walled-o nec osis
Po al Vein h ombus
Figu e 3:
On USG dec eased echogenici y o he panc eas
was ound in 17 pa ien s (30%) wi h he e ogenous
echo ex u e in 36 pa ien s (72%). Di ec
isualiza ion o gall bladde o CBD calculi was
no ed in 15 pa ien s (30%) while 6 pa ien s (12%)
showed a dila ed MPD. Pleu al e usion was no ed
in 9 cases (18%). Bulky head o he panc eas was
seen in 15 pa ien s (30%); Bulky body was also
no ed in 15 pa ien s (30%). A bulky panc ea ic ail
was seen in 12 pa ien s (24%). Pe ipanc ea ic
collec ion was seen in 27 pa ien s (54%) and
pe i enal collec ion in 8 pa ien s (16%). Pseudocys
could be diagnosed on ul asound in 13 cases
(26%); Walled o nec osis could be de ec ed in 4
cases (8%). Th ombus was de ec ed in he po al
ein on ul asound in 3 cases (6%) bu no h ombus
could be de ec ed in he splenic ein in any o he
cases. On CT, Pe ipanc ea ic a s anding was he
mos common inding seen in 44 pa ien s (88%).
Panc ea ic head enla gemen was seen in 23
pa ien s (46%),body enla gemen in 29 pa ien s
(58%) and ail enla gemen in 24 pa ien s (48%).
Acu e luid collec ion could be seen o in ol e he
head in 11 pa ien s (22%), body in 13 pa ien s
(26%) and ail in 14 pa ien s (28%). Addi ional
pe i enal and pa acolic/pel ic collec ions we e seen
in 12 pa ien s (24%) each wi h pleu al e usion in 9
pa ien s (18%). Well-encapsula ed pseudocys was
seen in ela ion o he head in 13 pa ien s (26%),
he body in 15 pa ien s (30%) and he ail in 15
pa ien s (30%). Acu e nec o ic collec ion was seen
in ol ing he head in 3 pa ien s (6%), body in 5
pa ien s (10%) and ail in 8 pa ien s (16%).
Addi ional pe i enal and pa acolic/pel ic
collec ions we e seen in 4 pa ien s each (8%). A
walled o nec osis was seen in ol ing he head in
3 pa ien s (6%), body in 6 pa ien s (12%) and ail in
3 pa ien s (6%). Po al ein h ombosis could be
de ec ed in 6 pa ien s (12%) and splenic ein
h ombosis in 2 pa ien s (4%). In ou s udy,
panc ea ic enla gemen was de ec ed in 50% o he
cases on CT scan as compa ed o 28% o cases on
ul asound. Pseudocys could be de ec ed in 28% o
he pa ien s on CT scan and 26% on USG. Walled-
o nec osis had an equal de ec ion a e o 8% on
USG and CT. Howe e , be e localiza ion o bo h
pseudocys and walled o nec osis was possible on
CT. Venous h ombosis was de ec able in 8% o
cases on CT scan compa ed wi h 3% cases on
USG.
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Bha acha ya e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
26
Discussion
In ou s udy, bo h ul asonog aphy (USG) and
con as -enhanced compu ed omog aphy (CECT)
we e ins umen al in de ec ing local complica ions
o acu e panc ea i is. Howe e , CECT p o ided
supe io isualiza ion and localiza ion o panc ea ic
and pe ipanc ea ic abno mali ies, consis en wi h
indings om p e ious s udies [11, 12, 15].
CECT’s abili y o iden i y complica ions such as
panc ea ic nec osis, pseudocys s, and enous
h ombosis aligns wi h i s es ablished ole as he
imaging modali y o choice o assessing acu e
panc ea i is [13,14]. The Re ised A lan a
Classi ica ion o e s a s anda dized amewo k o
ca ego izing acu e panc ea i is and i s
complica ions, emphasizing he ole o imaging in
s aging se e i y and guiding managemen [13,17].
Ou s udy’s indings a e consis en wi h his
classi ica ion, highligh ing he impo ance o
accu a e imaging in de e mining he ex en o
panc ea ic in ol emen and planning app op ia e
in e en ions [16]. Fu he mo e, he Modi ied CT
Se e i y Index (MCTSI) has been p oposed as a
ool o p edic ou comes in acu e panc ea i is by
assessing he ex en o panc ea ic and
pe ipanc ea ic in ol emen [14,19]. Ou s udy
suppo s he use o MCTSI in ou ine clinical
p ac ice o guide managemen decisions and p edic
pa ien ou comes [12, 20]. In conclusion, while
USG emains a aluable ool o ini ial e alua ion,
CECT o e s supe io diagnos ic accu acy o
de ec ing and localizing complica ions o acu e
panc ea i is. In eg a ing hese imaging modali ies,
along wi h s anda dized classi ica ion sys ems like
he Re ised A lan a Classi ica ion and MCTSI, can
enhance he managemen and p ognos ica ion o
pa ien s wi h acu e panc ea i is [11–20].
Conclusion
In ou s udy, bo h ul asonog aphy and con as -
enhanced CT we e e ec i e in de ec ing local
complica ions o acu e panc ea i is. CT p o ided
be e isualiza ion and localiza ion o panc ea ic
enla gemen , pseudocys s, walled-o nec osis, and
enous h ombosis compa ed o USG, making i a
mo e comp ehensi e ool o assessing he se e i y
and ex en o panc ea ic and pe ipanc ea ic
in ol emen .
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