Correlate Clinically For Pancreatitis on CT

Correlate clinically means that the radiologist believes a finding may represent an abnormality on CT.  The radiologist would like confirmation of this suspicion with the patient’s history and additional testing.  I see correlate clinically for pancreatitis at times in radiology reports.

Pancreatitis is an inflamed pancreas on CT.  I see this most commonly because of alcohol use and gallstones but there are many other causes.  On CT, most commonly the fat around the pancreas becomes hazy.  We call this fat stranding.   Sometimes the diagnosis is easy and you get haziness of the fat and fluid around the pancreas with an appropriate history and elevated lab values (amylase and lipase).  Other times it can be subtle or not apparent on CT.

Fat stranding can occur because of reasons other than pancreatitis.  Sometimes, haziness of the fat around the pancreas can occur because of other structures being inflamed like the adjacent duodenum.  The fat next to the pancreas can become hazy when there is more generalized edema or haziness.  Sometimes, the fat is hazy because of the way structures are imaged next to the pancreas (volume averaging) .

Lacking complete information about the patients history, laboratory values and physical exam findings, the radiologist may describe some haziness around the pancreas and recommend clinical correlation for pancreatitis.  Since pancreatitis can be confirmed with laboratory testing, this will confirm the diagnosis.  If the patients history and lab values do not support this, than pancreatitis becomes less likely.

Alternate diagnosis such as inflamed duodenum or ulcer disease should be considered.  Pancreatic cancer is another diagnosis that can be very subtle in it’s early stages.  There may be mild haziness of the fat and other subtle findings of the pancreas early on.  Sometimes, the finding is simply related to the way the structures are imaged and represent something we call volume averaging.

Therefore, correlate clinically for pancreatitis on CT is reasonable since the diagnostic criteria do not rely only on imaging.  The clinical presentation and laboratory values are also important for diagnosis.  Amylase and Lipase values are taken into consideration and measured with a blood test.  It’s also important to consider alternate diagnosis when the entire clinical picture does not support pancreatitis.

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