Criteria of Clavien et al for Identifying a Phlegmon of the Pancreas on CT Scan

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Release 21.0, Jan 2008

The Medical Algorithms Project

Chapter :

ch11. Hepatobiliary & Pancreas

Section :

Diagnosis and Prognosis of Pancreatitis

Criteria of Clavien et al for Identifying a Phlegmon of the Pancreas on CT Scan

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Reference

Overview :

Clavien et al listed criteria for distinguishing edema from phlegmon on CT images of the pancreas. This can help identify patients with severe acute pancreatitis. The authors are from the University of Geneva in Switzerland.

NOTE: Phlegmon is a nonspecific term that used less often today. Pancreatic necrosis is more commonly used.

Features in the Pancreas	Normal	Edema	Pancreatic Phlegmon
swelling	none	slight	significant
homogeneity	homogenous	homogenous	heterogenous
contrast enhancement	normal	decreased	avascular areas

Features of an Extrapancreatic Lesion	Normal	Edema	Extrapancreatic Phlegmon
margin	sharp	sharp	ill-defined
homogeneity	homogenous	homogenous	heterogenous
contrast enhancement	normal	none or decreased	possible wall enhancement
extent	normal	within anatomic barriers	extends beyond anatomic barriers
fatty tissue	normal	slightly elevated densities (-50 to +10 Hounsfield units)	replaced by fluid collections (+20 to +40 Hounsfield units)

Interpretation:

• If the diagnosis is in doubt, the lesion is classified as a phlegmon (page 458).

References:

Clavien P-A, Hauser H, et al. Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. Am J Surgery. 1988; 155: 457-466 (Table I, page 458).

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