Acute Pancreatitis: Radiological Detection and Clinical Significance of Pancreatic Ascites, Pleural and Parapancreatic Fluid Effusions

Fluid collections are common manifestations of local complications of acute pancreatitis (AP). The determination of fluid collections is important in stratifying the severity of the course of acute pancreatitis and choosing the appropriate management. In this study, the frequency of detection of fluid effusions by various instrumental methods and their clinical significance in 677 patient was assessed, taking into account the severity of the course of AP and anatomical localization of fluid accumulations. The computed tomography (CT) method showed its advantage in detecting fluid effusions in the pleural cavities, while the ultrasound method showed its indisputable significant advantage in the diagnosis of fluid effusions located parapancreatically and in the lesser sac: the highest frequency of detection of fluid effusion was in 65.3% of all patients in the general group using CT compared to 39% using ultrasound and 12.5% using chest X-ray (p<0.05). Each of the above methods showed different sensitivity depending on the anatomical areas of fluid effusion detection. In particular, the CT method revealed the presence of fluid in the pleural cavities in 50.7% of the total group, in the abdominal cavity in 36.0% of cases, and only in 8.0% of cases in the parapancreatic or lesser sac. The opposite picture was revealed when using the ultrasound method, in which fluid was found in the parapancreatic/lesser sac in the largest number of cases – 28.1%, in the abdominal cavity – in 22.6% of cases, and in the pleural cavity – in 14.3% of cases.