Case submitted by Runalaila I. Soon, M.D., via

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 The patient began a new medication several days prior to this CT scan. 

Enlarged and edematous pancreas seen on CT with moderate ascites and peritoneal stranding consistent with ascites.

 Interstitial edematous pancreatitis and necrotizing pancreatitis are two subtypes of acute pancreatitis (e.g. the Atlanta Classification). 

Patients often present with severe epigastric pain, elevated amylase and lipase and/or imaging findings on ultrasound, CT, or MR. Causes of pancreatitis are wide ranging, including, but not limited to, infection toxins, autoimmune processes, gallstones, alcohol abuse, metabolic disorders, trauma, drug-induced (as in this case). 

Complications, such as adjacent fluid collections, including abscess formation, is also possible. Vascular events, such as hemorrhage, splenic vein thrombosis, and portal vein thrombosis, may also be seen concurrently.

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What is the diagnosis in this patient with severe epigastric pain on a new medication?

Image IQ Quiz: Patient Presents with Severe Epigastric Pain