Phelan et al listed findings on computed tomography (CT) that are associated with pancreatic injury. These can help to identified a patient with significant pancreatic trauma. The authors are from multiple trauma centers in the United States (members of the American Association for Surgery of Trauma, AAST).


Findings indicative of pancreatic injury (hard signs):

(1) active bleeding involving the pancreas

(2) pancreatic hematoma

(3) pancreatic laceration

(4) heterogenous focal or diffuse enlargement of the pancreas

(5) heterogenous focal or diffuse pancreatic edema

(6) low attenuation of the pancreas


Fluid accumulations suggestive of pancreatic injury (soft signs):

(1) retroperitoneal fluid

(2) free intraperitoneal fluid

(3) fluid in the lesser sac

(4) fluid in the transverse mesocolon

(5) fluid surrounding the superior mesenteric artery

(6) fluid between the splenic vein and the posterior pancreas


Other findings suggestive of pancreatic injury (soft signs):

(1) edema of the peripancreatic fat

(2) inflammation of the peripancreatic fat

(3) inflammation of the mesentery

(4) thickening of the anterior perirenal fascia



• Imaging studies may fail to detect pancreatic injury.

• If pancreatic injury is detected, then it may not always indicate the severity.


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