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Revised Atlanta: pancreatitis collections

Banks 2013CTMRIPancreas
Figure · click to enlarge
Revised Atlanta collections at a glance

Collections are named by pancreatitis type (interstitial edematous vs necrotizing) and time from onset (4-week cutoff). Any collection can be sterile or infected; gas within it suggests infection.

<4 weeks≥4 weeks
Interstitial edematousAPFC acute peripancreatic fluid collection. Homogeneous fluid, no wall, adjacent to pancreasPseudocyst. Well-circumscribed, encapsulated, homogeneous fluid, no non-liquid component
NecrotizingANC acute necrotic collection. Heterogeneous, fluid and non-liquid content, no defined wall, intra- and/or extrapancreaticWON walled-off necrosis. Encapsulated, heterogeneous with non-liquid content

Pearls

  • Pseudocyst is rare after true interstitial pancreatitis; a "pseudocyst" with debris is usually WON — MRI or US shows solid debris better than CT.
  • Pancreatic parenchymal necrosis may not be evident until 72 h; early CT can underestimate it.
  • Disconnected pancreatic duct: necrosis of the neck/body with viable upstream gland; predicts recurrent collections.

Sources

  1. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis — 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–111.PubMed ↗
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Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.