[Benign non-organ-related diseases of the retroperitoneal space]

Because of the anatomic localisation of the retroperitoneal space, the detection and elucidation of pathology in the retroperitoneum calls for clinical acumen and the utilisation of imaging techniques. During the past two decades, efforts spearheaded by the work of M. A. Meyers led to an enhanced understanding of retroperitoneal anatomy and pathology. Conventional radiographic techniques are often incapable of detecting and/or characterising retroperitoneal abnormalities. Sonography may be limited by patient-dependent-factors. CT is unaffected by bowel gas and provides discrete cross-sectional images of the organs, fascial planes and retroperitoneal compartments, making it an ideal tool for assessment of retroperitoneal disease. In clinically stable patients MRT may be a useful modality for providing helpful and additional information in characterising retroperitoneal abnormalities. In this review article the diagnostic possibilities of benign not organ-related diseases of the retroperitoneum are described. This is intended to give the reader an insight into the etiology and distribution patterns of retroperitoneal fluid and gas collections as well as into diagnosis and differential diagnosis of benign retroperitoneal diseases. The diagnostic impact of the different imaging modalities is discussed.

Breast intraductal masses: US-guided fine-needle aspiration after galactography

PURPOSE

To evaluate ultrasonographic (US)-guided fine-needle aspiration (FNA) of intraductal masses performed immediately after galactography and to compare cytologic findings from US-guided FNA with those from nipple discharge.

MATERIALS AND METHODS

In 36 patients with nipple discharge from a single duct in one breast and intraductal masses diagnosed at galactography, US was performed to detect intraductal lesions and perform FNA before removal of the galactographic catheter. Cytologic analysis of nipple discharge, excisional biopsy, and histopathologic evaluation were performed in all patients.

RESULTS

Cytologic analysis revealed 23 nonpapillary benignancies, seven papillomas, five indeterminate cases, and one carcinoma. US-guided FNA cytologic analysis revealed 16 papillomas, 10 nonpapillary benignancies, five indeterminate cases, and three carcinomas. The two carcinomas misdiagnosed as papillomas at US-guided FNA cytologic analysis were papillary in situ carcinomas, while the three carcinomas correctly identified were invasive (only one was detected with cytologic analysis of nipple discharge). With cytologic analysis of nipple discharge, nine (25%) of 36 diagnoses were correct, and with US-guided FNA, 18 (50%) were correct (P = .0352).

CONCLUSION

Compared with cytologic analysis of nipple discharge, US-guided FNA cytologic analysis seems to add useful information for tailored surgical planning.

Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US

PURPOSE

To evaluate the ability of magnetic resonance (MR) imaging to depict solid debris within pancreatic collections prior to intervention and to help assess drainability, as well as to compare MR findings with those obtained at computed tomography (CT) and ultrasound (US).

MATERIALS AND METHODS

Nineteen collections in 18 patients were evaluated with MR imaging, CT, and US prior to drainage. Prospective, blinded interpretations of imaging studies by three independent readers (each interpreted all the images obtained with only one modality) evaluated collection characteristics (debris, consistency, septation, wall thickness, and irregularity) and predicted drainability. Findings were compared with clinical diagnosis and clinical outcome of drainage.

RESULTS

MR imaging and CT depicted all collections; US failed to depict two collections. In nine patients with subacute necrotic collections, solid debris was seen in eight (89%) at MR imaging, in two (22%) at CT, and in eight (89%) at US. In seven patients with pseudocysts, debris was seen in two (28%) at MR imaging and in none at CT, as well as in six (100%) of six at US. A collection was defined as "not drainable" on the basis of the depiction of solid necrotic debris more than 1 cm in diameter. With this definition, statistically significant differences between sensitivity and specificity values, respectively, were found for the prediction of actual drainability: MR imaging, 100% and 100%; CT, 25% and 100%; US, 88% and 54%.

CONCLUSION

Predrainage MR imaging should be performed in patients with subacute pancreatic collections to avoid infectious complications from unrecognized necrotic debris that cannot be removed with use of standard pseudocyst drainage techniques.

Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls

PURPOSE

To evaluate the postoperative computed tomographic (CT) appearance, complications, and potential pitfalls after a Puestow procedure (lateral side-to-side pancreaticojejunostomy).

MATERIALS AND METHODS

Forty CT examinations were performed after the Puestow procedure in 20 patients. Images were retrospectively reviewed by three radiologists.

RESULTS

The pancreaticojejunal anastomosis was identified at 30 examinations and was immediately anterior to the pancreatic body or tail. The anastomosis contained fluid or gas on 11 scans and oral contrast material on four scans. On 15 scans, the anastomosis appeared as collapsed bowel without gas, fluid, or oral contrast material. The Roux-en-Y loop was identified on 28 (70%) scans and contained fluid or gas on 16 scans and oral contrast material on six scans. The Roux-en-Y loop appeared as collapsed bowel on six scans. When the anastomosis or Roux-en-Y loop contained fluid and gas, the appearance mimicked that of a pancreatic or parapancreatic abscess. Peripancreatic stranding was present on 28 scans and was due to either ongoing pancreatitis or postoperative change. Complications included 15 transient fluid collections, three abscesses, four pseudocysts, one hematoma, and one small-bowel and Roux-en-Y obstruction.

CONCLUSION

Knowledge of the anatomy after a Puestow procedure is essential for accurate interpretation of CT scans.

Necrotizing fasciitis: CT characteristics

PURPOSE

To establish computed tomographic (CT) criteria for the diagnosis of necrotizing fasciitis.

MATERIALS AND METHODS

Twenty CT scans in 20 patients with pathologically proved necrotizing fasciitis were reviewed retrospectively for fascial thickening, fat infiltration, focal fluid collection, soft-tissue gas, muscle involvement, and intra-abdominal extension; the findings were correlated with clinical factors, including associated illnesses, disease site, treatment, and outcome.

RESULTS

Average patient age was 57.8 years; there were 13 men and seven women. Four patients (20%) died. Asymmetric fascial thickening and fat stranding were seen in 16 patients (80%). Gas tracking along fascial planes was present in 11 patients (55%), and abscesses were found in seven patients (35%). Infection sites were scrotum (n = 6), a lower extremity (n = 4), perineum (n = 4), neck (n = 2), back (n = 2), arm (n = 1), and abdomen (n = 1). Underlying illness (n = 17) was diabetes in 10 patients (50%), alcoholism in three (15%), chronic renal failure in two (10%), and drug abuse in two (10%).

CONCLUSION

CT criteria of asymmetric fascial thickening and gas are valuable in assessing suspected necrotizing fasciitis. CT also can provide information on coexistent deep collections.

CT of pancreatitis with renal and juxtarenal manifestations

Involvement of the juxtarenal spaces and kidneys in pancreatitis has been well known. Although delineation of the regions of accumulation of exudate has been elegantly confirmed with the advent and advance of refined computerized tomography (CT) there has been relatively little description in the earlier literature of these phenomena. This essay serves to illustrate the wide range of findings that have been encountered and recorded more recently.

Retroperitoneal collections--aetiology and radiological implications

PURPOSE

Retroperitoneal collections related to the psoas, in the absence of pancreatitis, are uncommon. This study reviews the imaging, pathogenesis and management of retroperitoneal collections with particular emphasis on distinguishing imaging features and the role of percutaneous drainage.

MATERIALS AND METHODS

Twenty-three retroperitoneal collections in 22 patients were reviewed in a 2-year period. Twenty-one patients underwent computed tomography (CT), with ultrasound (US) conducted in 14 and magnetic resonance imaging (MRI) in four. The clinical history and associated aetiological factors were noted. Methods of drainage were compared, pathological/microbiological results were recorded and the clinical outcome noted.

RESULTS

The mean age of presentation was 46.9 years (range 18-85 years). There was a male to female preponderance (17 to 6). Eighteen collections proved to be abscesses with five haematomas confirmed. Of the abscesses, three were primary and 15 were secondary to spinal, gastrointestinal or renal disease. Escherichia coli was the commonest isolated organism followed by Mycobacterium tuberculosis. No haematomas were drained. Twelve abscesses were drained successfully by percutaneous methods; three were managed with antibiotics alone; three were managed surgically.

CONCLUSION

Secondary abscesses predominate and investigation should be directed at excluding a gastrointestinal or renal source. Tuberculous disease remains a significant problem. Percutaneous drainage allows effective management, even in the presence of a secondary abscess.

Sonography of the musculoskeletal system in dogs and cats

Sonography of the musculoskeletal system in dogs and cats was undertaken to evaluate the application of this imaging procedure in orthopedics. In most of the patients a 7.5 MHz linear transducer was used because of its flat application surface and its resolving power. The evaluation of bone by sonography is limited, but sonography can provide addition information regarding the bone surface and surrounding soft tissue. Ultrasound is valuable for assessing joint disease. Joint effusion, thickening of the joint capsule and cartilage defects can be identified sonographically. It is also possible to detect bone destruction. Instabilities are often identified with the help of a dynamic examination. Soft tissue abnormalities of the musculoskeletal system lend themselves to sonographic evaluation. Partial or complete muscles or tendon tears are able to be differentiated and the healing process can be monitored. Most of the diseases that are in the area of the biceps or the achilles tendon, such as dislocation of the tendon, old injuries with scarification, free dissecates in the tendonsheath, tendinitis and/or tendosynovitis can be differentiated by sonography. In addition, with clinical and laboratory findings, it is often possible to make a correct diagnosis with ultrasound in patients with abscesses, foreign bodies, hematomas, soft tissue tumors and lipomas.

Detection of traumatic complications of cardiopulmonary resuscitation by ultrasound

STUDY OBJECTIVE

We conducted a pilot study to assess the feasibility of ultrasonography in the detection of traumatic complications of CPR.

METHODS

A prospective case series was undertaken with a convenience sample of 21 emergency department patients who sustained nontraumatic cardiopulmonary arrest. A 5- to 7-minute ultrasound examination was performed during resuscitation. The presence or absence of free fluid was noted in the left and right upper quadrants, coronal views of the kidneys, the pelvis, and the pericardium; autopsies to determine the source of fluid were not performed. Cardiac activity and the concurrent electrical rhythm were also noted. All ultrasonographers had previously been trained in the use of this technique for the evaluation of trauma patients. Examinations were stored on videotape for further review.

RESULTS

Seven of 20 patients (29%) had findings on ultrasound that could have resulted from CPR-related trauma. In one additional case, findings of free fluid were probably the result of preexisting illness (ascites). Pericardial effusion was found in three patients, perihepatic fluid in four, pleural fluid in one, perirenal fluid in four, perisplenic fluid in two, and pelvic fluid in three; several patients had multiple findings. Cardiac motion with pulseless electrical activity was noted in seven patients. Five patients had return of spontaneous circulation and survived to hospitalization, and one survived to discharge.

CONCLUSION

Traumatic complications of CPR are well known but typically difficult to assess. Ultrasonography may identify injuries, help guide procedures, and serve as a means to assess pharmacologic effects on cardiac performance during CPR. It is a readily available, noninvasive means to assess these critically ill patients.

Supraciliary effusions and ciliary body thickening after scleral buckling procedures

PURPOSE

The purpose of the study was to use ultrasound biomicroscopy to identify and quantity changes in anterior segment parameters after scleral buckling procedures.

METHODS

Ultrasound biomicroscopy was used to examine 15 patients with retinal detachment within 1 week before and after surgery. Quantitative measurements were performed of anterior chamber depth, supraciliary effusion depth, ciliary body thickness, and angle opening.

RESULTS

Supraciliary fluid was present after surgery in 12 patients (80%). Average supraciliary fluid depth was 0.16 +/- 0.13 mm. Ciliary body thickness measurements at a point 2-mm posterior to the scleral spur increased after surgery in all patients an average of 0.15 +/- 0.10 mm. There was a strong correlation between ciliary fluid levels and change in ciliary body thickness (r = 0.742, P < 0.01). Anterior chamber depth decreased after surgery in 14 patients (93%). A decrease of angle opening of greater than 5 degrees was noted in 11 patients (73%). In all of these 11 patients, the ciliary body and iris root were considered to be rotated anteriorly. Six (55%) of 11 of these patients showed anterior bowing of the iris, indicating pupillary block. Complete angle closure occurred over one to three quadrants in three patients, but none of these patients had complete angle closure or glaucoma.

CONCLUSIONS

Supraciliary effusions and ciliary body thickening are common after scleral buckling procedures and can produce conditions conducive to angle closure. Angle narrowing occurs through a combination of direct anterior iris rotation and induced pupillary block.

[Echographic follow-up after radical prostatectomy]

The abdominal and transrectal ultrasound is of a great importance in the follow-up and in the early postoperatory control in the patients which have undergone a radical prostatectomy. The abdominal ultrasonography can be used to identify the presence of abdominal or pelvic fluid collections in the postoperative period or to evaluating the upper urinary tract. Ultrasonography has come to play a primary role in the detection of lymphonodal and/or parenchymal metastasis. Transrectal ultrasound permits to identify the local illness relapse, whereas the ultrasonography examination during micturition allows the functional study of the bladder neck. Moreover, transrectal ultrasound is useful in guiding biopsy needle into a specific lesion seen on the sonogram in the perianastomotic region whereas random ecoguided biopsy in the perianastomotic area is necessary in patients with signs of recurrent cancer even in the absence of suspicious areas.

[Echo-guided drainage of pararenal and pelvic fluid accumulations: technique, indications, and results]

Percutaneous echoguided drainage of retroperitoneal collections is to be considered a recommendable technique which guarantees a good percentage of success and a complete resolution of the effusions and also gives a low percentage of complications. The drainage can be made through a simple percutaneous needle puncture or through a catheter which is kept for some days. The latter technique done by Seldinger or Trocar's method, guarantees more possibilities of success. The systemic echographic control during the post-operatory period of the urological patients have permit to find out the high frequency of small fluid effusions (haematic, urinary or lymphatic) in the operation area; not all the collections need a treatment. The urinary collections or those with clinical signs of anemia have to be drained. In the presence of small haematic or lymphatic collections, the ultrasonography follow-up shows almost always a progressive volume reduction with a following disappearance. Percutaneous drainage has to be performed in the presence of a large collection (more than 5 cm of diameter), in the case of a persistent collection or when patient presents with clinical features of infection.

Sludge in fetal gallbladder: natural history and neonatal outcome

Normal and pathological conditions of the fetal gallbladder have been a subject of recent investigation by ultrasonographers. Fetal gallstones are the most common abnormal finding and appear as echogenic foci within the gallbladder. We report a series of five fetuses in whom the gallbladders were filled with sludge which appeared as a pear shape echogenic structure. In the majority of cases, gallbladder sludge mimicked intrahepatic calcification or echogenic bowel. Serial ultrasound examinations of these fetuses revealed good interval growth. The gallbladders remained echogenic and were normal in size in three cases and were moderately enlarged in two. All neonates were born in normal condition with no identifiable malformations. Follow-up was obtained in four infants using abdominal ultrasound. A normal appearing sludge free gallbladder was seen in three neonates at 6 weeks of life and in four infants at 12 weeks. Accurate diagnosis of gallbladder sludge will spare the patient unnecessary work-up and anxiety. The natural history of gallbladder sludge in the fetus is benign in nature and is similar to that of fetal gallstones.

Laparoscopic treatment of secondary infected pancreatic collections after an acute pancreatitis: two cases

We report two cases of secondary infected pancreatic necrosis following a pancreatitis treated by a laparoscopic approach. The treatment consisted in a necrosectomy and the installation of a system of drainage and lavage.

Improving the detection of radiographically occult ankle fractures: positive predictive value of an ankle joint effusion

OBJECTIVE

To assess the value of an ankle effusion on plain radiographs as a predictor of radiographically occult fracture after acute ankle trauma.

PATIENTS

Consecutive patients with acute ankle trauma and radiographic evidence of an ankle joint effusion. Patients were excluded if ankle trauma was sustained more than 48 h previously or if a fracture was visible on initial photographs.

METHODS

All subjects (n = 26) underwent computed tomography (CT) of the ankle in sagittal and coronal planes. Ankle effusion size was measured from initial lateral ankle radiographs.

RESULTS

Twelve patients (46%) had radiographically occult fractures identified with CT. Fracture sites included: posterior or lateral malleoli (n = 4), calcaneus (n = 1), or talus (n = 7). Ankle effusion size was 11.2 mm in the group without fracture and 17.1 mm in the group with fracture (P < 0.0001). The positive predictive value of an effusion 15 mm or greater was 83%. CT detected significant soft-tissue injuries in four (15%) patients including peroneal retinaculum tear (n = 1), anterior talofibular ligament avulsion (n = 1), and tears of the peroneus longus (n = 1) and tibialis posterior (n = 1) tendons.

CONCLUSIONS

The presence of a large ankle effusion of radiographs after acute ankle trauma suggests an underlying fracture. An ankle effusion of > or = 15 mm is a reasonable threshold to prompt additional imaging. Computed tomography provides good visualization of subtle bone injuries and may detect clinically imported soft-tissue injuries.

Suprachoroidal effusion following argon laser trabeculoplasty

PURPOSE

This is first report of suprachoroidal effusion occurring subsequent to argon laser trabeculoplasty (ALT).

METHODS

Review of the records of the patients in question.

RESULTS

A 77-year-old woman with bilateral pseudophakia and primary open-angle glaucoma was treated with ALT when her visual fields deteriorated despite topical timolol therapy. Although ALT was initially performed without complication in one eye, treatment of the other eye led to a choroidal detachment. This was associated with temporary reduction in visual acuity, shallowing of the anterior chamber and hypotony.

CONCLUSION

Suprachoroidal effusion appears to be another complication of ALT. In the reported case, this application and its effects were temporary and resolved with conservative management.

Occult ankle fracture detected by an ankle effusion on plain radiography: a case report

Subtle ankle fractures may escape detection on plain radiography. These occult fractures can cause prolonged disability and pain. We present a case of blunt ankle trauma where plain radiography failed to reveal any bony abnormalities. The recognition of an ankle effusion on plain radiographs prompted us to perform a computed tomography (CT) scan of the ankle. The CT scan demonstrated an anterior plafond fracture of the distal tibia, which required surgical fixation. Had the fracture not been identified, our patient would have been treated inappropriately for a ligament sprain. An occult fracture should be suspected if an ankle is grossly swollen after blunt trauma, and plain radiography demonstrates an effusion. In this circumstance, performance of further imaging studies, such as conventional or CT, are advised to rule out an occult ankle fracture.

Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections

PURPOSE

To correlate anatomic dissections with clinical observations regarding anatomic distribution of retroperitoneal fluid, and to document the existence of planes that lie between classically described retroperitoneal spaces.

MATERIALS AND METHODS

Latex was injected in varying amounts into the pancreatic tail in three fresh cadavers to simulate peripancreatic fluid collections. Spiral computed tomography (CT) was performed of the abdomen and pelvis after each latex injection. Two cadavers were subsequently frozen and sectioned in axial planes; limited dissections were performed on these specimens. One was embalmed and underwent extensive anatomic dissection. Five embalmed, unprepared cadavers were also dissected to confirm observations made in the three prepared cadavers.

RESULTS

Latex injected into the tail of the pancreas entered a retromesenteric plane that was posterior to the anterior pararenal space and anterior to the anterior renal fascia. The plane continued superiorly, extending to the diaphragm near the esophageal hiatus; inferiorly, extending to the pelvis along the anterolateral surface of the psoas muscle; and laterally, posterior to the descending colon and its mesentery. The plane also communicated with a retrorenal plane lying between the posterior renal fascia and the posterior pararenal space.

CONCLUSION

Embryologic development of the dorsal mesenteries suggests the existence of retromesenteric planes, and clinical observations further support their existence. These findings may explain the observed distribution of retroperitoneal fluid collections from diaphragm to pelvis.

Ultrasound-guided fluid aspiration and prenatal diagnosis of duplicated hydrometrocolpos with uterus didelphys and septate vagina

We report on a case of duplicated hydrometrocolpos with uterus didelphys, a septate vagina, lower vaginal atresia, a persistent urogenital sinus, left ear agenesis, a single umbilical artery, and an imperforate anus, but without the associated features of McKusick-Kaufman syndrome such as polydactyly and congenital heart defects. Ultrasound-guided fluid aspiration of the fetal intrapelvic cystic mass helped to decompress the distended genital organs, decrease the severity of the urinary tract obstruction, delineate the ultrasonographic image of duplicated hydrometrocolpos to differentiate it from other intrapelvic cystic masses, and obtain fluid for cytological analysis.

Power Doppler sonography in the assessment of musculoskeletal fluid collections

OBJECTIVE

Power Doppler sonography is a relatively new technique that has been shown to depict hyperemia associated with musculoskeletal inflammatory disease. We performed this study to evaluate the ability of power Doppler sonography to differentiate musculoskeletal fluid collections of varying etiologies.

SUBJECTS AND METHODS

Gray-scale and power Doppler sonography were performed on 39 patients with joint effusions or appendicular fluid collections. Blood flow (hyperemia) in the soft tissues adjacent to the fluid collections was subjectively analyzed and graded on a scale of 1 to 4 (1, normal flow; 2-4, increasing degrees of hyperemia). All fluid collections were aspirated within 24 hr of the sonographic examination. We found 31 joint effusions and 12 periarticular collections with appropriate imaging and pathologic correlation.

RESULTS

Adjacent to 36 effusions and fluid collections, we saw moderate or marked hyperemia. Thirty-five of the 36 had an inflammatory or neoplastic cause, including 15 infected collections. One fluid collection had a degenerative etiology (subdeltoid bursitis secondary to supraspinatus tendon tear). Adjacent to the seven remaining effusions and fluid collections, we saw normal or mildly increased hyperemia; none of these collections had an inflammatory etiology.

CONCLUSION

Power Doppler sonography helps distinguish inflammatory and infectious musculoskeletal fluid collections from those that are noninflammatory, and it may help guide the decision to perform diagnostic aspiration. Power Doppler sonography does not reliably differentiate between inflammatory collections of infectious and noninfectious origin because collections of either origin may significantly increase adjacent soft-tissue perfusion.

Change in endometrial thickness in postmenopausal women undergoing hormone replacement therapy

PURPOSE

To evaluate the effect over time of hormone replacement on endometrial thickness in asymptomatic postmenopausal women.

MATERIALS AND METHODS

Endometrial thickness was measured on 644 sonograms of 120 postmenopausal volunteers receiving no hormones or one of three hormone regimens. Each subject underwent ultrasound (US) two to nine times. In addition, eight women using sequential hormones underwent US seven to 20 times over 2 months. The greatest endometrial thickness and change in endometrial thickness over time were evaluated.

RESULTS

Endometrial thickness was statistically significantly greater in women using sequential hormones (8 mm) compared with that in control subjects (5 mm). Change in endometrial thickness (> 3-mm difference) was seen in 23 of 40 women using sequential hormones compared with six of 61 controls. Women using sequential hormones demonstrated maximum endometrial thickness on days 13-23 of the cycle.

CONCLUSION

Women using sequential hormones show greater endometrial thickness than that in controls and show the most variation in measurements. They should undergo US either early or late in the hormone cycle to evaluate the endometrium at its thinnest.

Sonographic diagnosis of peritoneal inclusion cysts

Peritoneal inclusion cysts have not received the attention they merit in the imaging literature. We present a series of peritoneal inclusion cysts and describe their sonographic features. Our findings lead us to encourage more conservative therapies. All seven patients in our series had pelvic pain and had undergone surgery previously. An ovary surrounded by septations and fluid was the most common finding by transvaginal sonography. Doppler examination showed low resistive flow in the septations. Conservative therapy was used in five cases with excellent results. We found that a confident diagnosis of peritoneal inclusion cysts is possible with ultrasonography. This diagnosis should encourage the use of more conservative therapy.

CT diagnosis of pancreatic injury in children: significance of fluid separating the splenic vein and the pancreas

OBJECTIVE

The purpose of our study was to evaluate the relationship of fluid between the splenic vein and the pancreas to fluid in the anterior pararenal space in children following blunt trauma and to assess the usefulness of detecting fluid separating the splenic vein and the pancreas in the CT diagnosis of pancreatic injury in children.

MATERIALS AND METHODS

Twenty-five of 1725 consecutive children who underwent abdominal CT following blunt trauma had surgically or autopsy-proven pancreatic injury or clinical pancreatitis. An additional 29 children who underwent CT for evaluation of blunt trauma did not have pancreatic injury and were prospectively noted to have fluid in the anterior pararenal space. CT findings (visceral injury or intraperitoneal or extraperitoneal fluid) were recorded at the time of initial interpretation in all children. The CT scans of these 54 children were reviewed for the presence of fluid separating the splenic vein and the pancreas.

RESULTS

Fluid separating the splenic vein and the pancreas was noted in 15 (60%) of 25 children with pancreatic injury and in 14 (48%) of 29 children who had fluid in the anterior pararenal space without pancreatic injury. In 14 of 15 children with pancreatic injury and fluid between the splenic vein and the pancreas, additional collections of peripancreatic fluid (anterior pararenal space or lesser sac) were also noted. In another four children with pancreatic injury, additional collections of peripancreatic fluid were noted in the absence of fluid between the splenic vein and the pancreas.

CONCLUSION

Fluid separating the splenic vein and the pancreas on CT scans is a nonspecific finding usually associated with fluid in the anterior pararenal space. Although it may be seen in conjunction with pancreatic injury, it is rarely the only abnormal CT finding in such an injury.