Peripancreatic Stranding on Radiology Reports: What It Means

ByA. Mendelson, MD
Please read the disclaimer

Peripancreatic stranding is a phrase you may see on a CT scan report after an emergency room visit or evaluation for abdominal pain. The wording can sound alarming, but in many most cases it simply means there is inflammation around the pancreas. This article explains what peripancreatic stranding looks like on imaging, why it happens, the conditions it is most commonly linked to, and what it means for your health.

What Peripancreatic Stranding Looks Like on CT

On a CT scan, the pancreas sits deep in the upper abdomen. The fat surrounding it normally looks smooth and uniform. When the pancreas or the nearby soft tissues become inflamed, the fat becomes streaky or fuzzy. This change in appearance is called “stranding.”

Radiologists use the term stranding to describe the wispy, hazy lines in the fat next to an organ. When this occurs around the pancreas, it is labeled peripancreatic stranding. It often appears as:

  • Light, streaky lines in the fat around the pancreas

  • A less sharp or slightly blurred border of the pancreas

  • Mild thickening of tissues around the gland

Peripancreatic stranding itself is not a diagnosis. It is a sign that something nearby has caused inflammation.

Why Peripancreatic Stranding Happens

Stranding occurs when there is inflammation in or around the pancreas. This inflammation may be mild or more pronounced depending on the underlying cause.

The most common reasons for peripancreatic inflammation include:

  • Irritation of the pancreatic tissue

  • Leakage of digestive enzymes during an episode of pancreatitis

  • Swelling of nearby fat or small blood vessels

  • Infection or inflammation in adjacent organs

Most Common Causes

Acute Pancreatitis

Acute pancreatitis is the most frequent cause of peripancreatic stranding on CT. In this condition, the pancreas becomes inflamed due to gallstones, alcohol use, high triglycerides, certain medications, or other triggers. When enzymes leak out of the pancreas, they irritate surrounding tissues and create the stranding pattern.

Typical CT signs of acute pancreatitis include:

  • Stranding around the pancreas

  • Enlargement of the pancreas

  • Fluid or mild swelling in the surrounding tissues

Mild acute pancreatitis often resolves with supportive treatment, such as IV fluids and rest.

Mild Fat Inflammation Without Full Pancreatitis

Sometimes imaging shows peripancreatic stranding even when blood tests and symptoms do not fully match pancreatitis. This can happen when the pancreas is mildly irritated or when nearby fat is inflamed from another cause.

Infection Near the Pancreas

In rare cases, infections like abscesses or spread of infection from the bowel or biliary system can cause stranding. CT usually shows additional clues if infection is present, such as fluid collections or air pockets.

Gallbladder or Biliary Problems

Gallstones or inflammation of the bile ducts can irritate tissues around the pancreas because these systems are closely connected. A gallstone blocking the bile duct is a classic trigger for acute pancreatitis and often leads to visible stranding.

Trauma

Injury to the upper abdomen can cause temporary swelling or bruising of the pancreas and surrounding fat. CT then shows stranding as part of the body’s natural response.

Post-Procedural Changes

Endoscopic procedures, biopsies, and surgeries near the stomach, liver, or pancreas can temporarily inflame the area. This often produces mild peripancreatic stranding that improves as healing occurs.

How Radiologists Interpret Stranding

Radiologists look for additional findings when they see peripancreatic stranding:

  • How much stranding is present
    More stranding may suggest more severe inflammation

  • Whether the pancreas is enlarged
    Enlargement supports a diagnosis of pancreatitis.

  • Whether there is fluid or a collection near the pancreas
    This helps the care team determine severity.

  • Whether other organs show inflammation
    The stomach, duodenum, bile ducts, and liver can be involved.

  • Whether the pancreatic duct looks normal
    The duct can become dilated when there is pancreatitis or a tumor of the pancreas.

Symptoms That May Accompany Peripancreatic Stranding

Many people with stranding have symptoms such as:

  • Upper abdominal pain

  • Nausea or vomiting

  • Pain that radiates to the back

  • Bloating or early fullness

In mild cases, symptoms can be subtle. In severe inflammation, symptoms may be more intense.

Does Peripancreatic Stranding Always Mean Pancreatitis?

Not necessarily. While pancreatitis is the most common explanation, stranding can appear in other conditions.  Your doctor will correlate the CT findings with symptoms and lab results, especially amylase and lipase levels. If these enzyme levels are normal and symptoms are mild, the stranding may be nonspecific inflammatory change rather than full-blown pancreatitis.

How Peripancreatic Stranding Is Managed

Treatment depends on the underlying cause:

If pancreatitis is suspected

Typical management includes:

  • IV fluids

  • Resting the digestive tract with a temporary change in diet

  • Pain control

  • Avoiding triggers like alcohol or large fatty meals

If gallstones are involved

Your care team may recommend an ultrasound or MRCP to look for stones, and sometimes removal of the gallbladder.

If stranding is mild and nonspecific

Rest, hydration, and monitoring symptoms are usually enough.

If infection is a concern

Further imaging or labs may be required. CT, MRI, or repeat ultrasounds help determine whether findings are progressing.

Follow-Up Imaging

Mild stranding does not always require repeat imaging. Follow-up studies are usually reserved for:

  • Worsening symptoms

  • Concern for complications

  • Persistent pain

  • Complex pancreatitis or fluid collections

Your physician will determine whether imaging should be repeated.

Conclusion

Peripancreatic stranding means the fat around the pancreas looks inflamed. It is most often linked to acute pancreatitis but can also develop from gallbladder problems, infections, trauma, or prior procedures.  Correlating symptoms, history, lab values and imaging helps to determine the most likely cause of peripancreatic stranding.   Many cases improve with supportive treatment, monitoring, and treating the underlying cause.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC3473535/

https://pmc.ncbi.nlm.nih.gov/articles/PMC8292294/

https://www.jacr.org/article/S1546-1440%2819%2930604-0/fulltext

Disclaimer: The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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