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Radiographics : a Review Publication of... 2016The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute... (Review)
Review
The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute pancreatitis and associated complications based on research advances made over the past 2 decades. Acute pancreatitis is now divided into two distinct subtypes, necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively. The revised classification system also updates confusing and sometimes inaccurate terminology that was previously used to describe pancreatic and peripancreatic collections. As such, use of the terms acute pseudocyst and pancreatic abscess is now discouraged. Instead, four distinct collection subtypes are identified on the basis of the presence of pancreatic necrosis and time elapsed since the onset of pancreatitis. Acute peripancreatic fluid collections (APFCs) and pseudocysts occur in IEP and contain fluid only. Acute necrotic collections (ANCs) and walled-off necrosis (WON) occur only in patients with necrotizing pancreatitis and contain variable amounts of fluid and necrotic debris. APFCs and ANCs occur within 4 weeks of disease onset. After this time, APFCs or ANCs may either resolve or persist, developing a mature wall to become a pseudocyst or a WON, respectively. Any collection subtype may become infected and manifest as internal gas, though this occurs most commonly in necrotic collections. In this review, the authors present a practical image-rich guide to the revised Atlanta classification system, with the goal of fostering implementation of the revised system into radiology practice, thereby facilitating accurate communication among clinicians and reinforcing the radiologist's role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. (©)RSNA, 2016.
Topics: Acute Disease; Diagnostic Imaging; Disease Progression; Humans; Pancreatitis; Practice Guidelines as Topic; Terminology as Topic
PubMed: 27163588
DOI: 10.1148/rg.2016150097 -
Digestive Endoscopy : Official Journal... Nov 2021Chronic pancreatitis (CP) is an inflammatory process characterized by irreversible morphological changes in the pancreas. Pain is the predominant symptom observed during... (Review)
Review
Chronic pancreatitis (CP) is an inflammatory process characterized by irreversible morphological changes in the pancreas. Pain is the predominant symptom observed during the course of CP. The etiopathogenesis of pain in CP is multifactorial and includes ductal hypertension due to obstruction of the pancreatic duct (PD), neuropathic causes, and extrapancreatic complications of CP like pseudocyst and distal biliary obstruction. A sizeable proportion of patients with CP are amenable to endoscopic treatment. The mainstay of endotherapy includes decompression of PD with one or more plastic stents in those with stricture, and fragmentation of PD calculi using extracorporeal shock wave lithotripsy. Nearly two-thirds of the patients achieve pain relief in the long term with endotherapy. Upfront assessment for the suitability of endotherapy is paramount to achieve the best outcomes. The predictors of poor response to endotherapy include multifocal disease, like those with multifocal strictures or multiple calculi throughout the pancreas, or a combination of both PD strictures and stones. With the emerging use of covered metal stents, the outcomes are likely to improve in cases with refractory PD strictures as well as CP-related distal biliary obstruction. The optimum stent design and indwell time of metal stents in cases with refractory PD strictures need further evaluation. Endoscopic ultrasonography has emerged as a complementary endoscopic modality in the management of CP as well as associated complications like pseudocysts, refractory pain, and vascular complications.
Topics: Calculi; Cholangiopancreatography, Endoscopic Retrograde; Humans; Lithotripsy; Pancreatic Ducts; Pancreatitis, Chronic; Sphincterotomy, Endoscopic; Stents; Treatment Outcome
PubMed: 33687105
DOI: 10.1111/den.13968 -
Khirurgiia 2022To select the optimal treatment for uninfected and suppurative rare mediastinal pancreatobiliary pseudocysts.
OBJECTIVE
To select the optimal treatment for uninfected and suppurative rare mediastinal pancreatobiliary pseudocysts.
MATERIAL AND METHODS
There were 10 patients with mediastinal pancreatogenic (=9) and biliogenic (=1) pseudocysts formed through esophageal (=9) and aortic (=1) hiatus of the diaphragm. All patients were divided into groups: group A - uninfected pancreatic pseudocysts (=5) formed through esophageal hiatus; group B - 5 patients with suppurative pancreatogenic (=4) and biliogenic (=1) mediastinitis complicated by biliopleuroesophageal (=1), pancreatoesophageal (=1) and pancreatopleural (=2) fistulas.
RESULTS
In the group A, simultaneous procedures (=5) were performed depending on pancreatic parenchyma and pancreatic duct destruction. Distal ductal obstruction required Frey procedure (=3). If distal duct was patent, we resected cyst-containing pancreatic tail (=2). Early and long-term results were favorable. In the group B, mediastinitis persisted for a long time with normal temperature as a rule. In our opinion, mild course is associated with gradual introduction of purulent tissues into mediastinum and development of a tissue barrier. Two-stage surgeries were performed in patients with pancreatopleural empyema. Mediastinitis lasting 6-8 weeks caused perforation of the lower third of esophagus (=2) and death of 1 patient. Risk factors of mediastinal pseudocysts: hypertension in pancreatic duct and pseudocysts, immobile cicatricial tissues of omental bursa, proximity of subdiaphragmatic structures to esophageal and aortic hiatus of the diaphragm. Pressure in aortic canal (mmHg) is 10 times higher than in esophageal canal that increases migration through the esophageal hiatus. It is advisable to distinguish pancreatoesophageal and biliopleuroesophageal fistulas.
CONCLUSION
Uninfected mediastinal pseudocysts require simultaneous procedures, pancreatopleural empyema - two-stage interventions. Therapy is recommended in patients with esophageal fistula and no severe symptoms and intoxication.
Topics: Drainage; Humans; Mediastinum; Pancreas; Pancreatic Ducts; Pancreatic Pseudocyst
PubMed: 35289550
DOI: 10.17116/hirurgia202203156 -
Trends in Parasitology Dec 2023Recent studies have proposed that Trichomonas vaginalis, the causative agent of trichomoniasis [the most common nonviral sexually transmitted infection (STI) in humans]... (Review)
Review
Recent studies have proposed that Trichomonas vaginalis, the causative agent of trichomoniasis [the most common nonviral sexually transmitted infection (STI) in humans] can establish persistent infections in the vagina. T. vaginalis infections are often asymptomatic but can have adverse consequences such as increased risk of HIV-1 infection and cervical cancer. Despite this, it remains an understudied infection. A potential agent of persistent infections is the 'pseudocyst', a spherical form of T. vaginalis identified by several laboratories and linked to persistence in related species such as the avian parasite Trichomonas gallinae and cattle parasite Tritrichomonas foetus. Additional robust and reproducible research on pseudocysts and persistent T. vaginalis infections is required, which may ultimately shed light on how to better diagnose and treat trichomoniasis.
Topics: Female; Humans; Animals; Cattle; Trichomonas vaginalis; Persistent Infection; Trichomonas Infections
PubMed: 37806787
DOI: 10.1016/j.pt.2023.09.009 -
The American Journal of Emergency... Nov 2021A 51-year-old female with prior history of ventriculoperitoneal shunt presented with worsening abdominal distension. Her abdomen was diffusely tender and firm with a...
A 51-year-old female with prior history of ventriculoperitoneal shunt presented with worsening abdominal distension. Her abdomen was diffusely tender and firm with a slight fluid wave. CT imaging with IV contrast was notable for a large cystic lesion in the abdominal cavity with the differential of CSF pseudocyst versus ovarian mass. She underwent paracentesis of the cyst with interventional radiology and required a revision of her ventriculoperitoneal shunt. CSF pseudocysts are a rare complication of ventriculoperitoneal shunts, however, are an important consideration in patients presenting with abdominal complaints and require specialized intervention and assessment.
Topics: Cerebrospinal Fluid; Cysts; Drainage; Female; Humans; Middle Aged; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt
PubMed: 33975742
DOI: 10.1016/j.ajem.2021.04.041 -
Injury Feb 2017Traumatic pulmonary pseudocysts (TPP) are underreported cavitary lesions of the pulmonary parenchyma that can develop following blunt chest trauma. Although the... (Review)
Review
BACKGROUND
Traumatic pulmonary pseudocysts (TPP) are underreported cavitary lesions of the pulmonary parenchyma that can develop following blunt chest trauma. Although the occurrence of traumatic pulmonary pseudocyst is rare, this condition should be considered in the differential diagnosis of any cavitary lesion. Awareness of this injury and its clinical significance is important for successful management in order to avoid medical errors in the course of treatment.
METHODS
A literature search was conducted through Medline using the key phrases "traumatic pulmonary pseudocyst" and "traumatic pneumatocele." Relevant articles, especially those with focus on diagnosis and management of traumatic pneumatocele in adults, were selected. Due to the scarcity of literature and lack of Level I evidence on this subject, studies published in any year were considered.
RESULTS
A search of "traumatic pulmonary pseudocyst" and "traumatic pneumatocele" yielded 114 studies. Most of these were excluded based on inclusion and exclusion criteria. Thirty-five articles were reviewed. The majority of these were individual case studies; only eight articles were considered large case studies (greater than eight patients).
CONCLUSION
Traumatic pulmonary pseudocysts are lesions that occur secondary to blunt chest trauma. Diagnosis is based on a history of trauma and appearance of a cystic lesion on CT. Accurate diagnosis of traumatic pulmonary pseudocyst is imperative to achieve successful outcomes. Failure to do so may lead to unnecessary procedures and complications.
Topics: Cysts; Diagnosis, Differential; Hemopneumothorax; Humans; Lung Injury; Practice Guidelines as Topic; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 27986273
DOI: 10.1016/j.injury.2016.12.006 -
Revista Espanola de Enfermedades... Jun 2020Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis,... (Review)
Review
Pancreatic fluid collections frequently occur in the context of moderate and severe acute pancreatitis, and may also appear as a complication of chronic pancreatitis, pancreatic surgery or trauma. It is essential to adhere to the Atlanta classification nomenclature that subclassifies them into four categories (acute peripancreatic fluid collections, acute necrotic collections, pseudocysts, and walled-off necrosis) since it has an impact on prognosis and management. Pseudocysts and walled-off pancreatic necrosis are encapsulated pancreatic fluid collections characterized by a surrounding inflammatory wall, which typically develops three to four weeks after the onset of acute pancreatitis. Most pancreatic fluid collections resolve spontaneously and do not require intervention. However, when they become symptomatic or complicated drainage is indicated, and endoscopic ultrasound-guided drainage has become first-line treatment of encapsulated collections. Drainage of pseudocysts is relatively straightforward due to their liquid content. However, in walled-off necrosis the presence of solid necrotic debris can make treatment more challenging and therefore multidisciplinary management in experienced centers is recommended, being a step-up approach the current standard of care. In this review, we aim to address the management of pancreatic fluid collections with an especial focus on endoscopic drainage.
Topics: Acute Disease; Drainage; Humans; Pancreatic Pseudocyst; Pancreatitis, Acute Necrotizing
PubMed: 32450706
DOI: 10.17235/reed.2020.6814/2019