35 year old alcoholic patient with acute abdominal pain

Axial CECT abdomen scan at the level of pancreas(1) show necrosis of the body and tail of pancreas with associated peripancreatic fat inflammation. Necrosis involves more than 30% of volume of pancreas(2) – this indicates a higher score as per the Modified CT Severity index of acute pancreatitis. At a closer look we can also see hypodense filling defect in the splenic vein in image 1 suggestive of thrombosis. Mild bilateral pleural effusions also noted(3). Ascitis is seen in the pelvis that shows hyperdense attenuation to clear urine(fluid) in the urinary bladder(sagittal CECT image 4). Arterial phase was also acquired for this patient whereby splenic artery was inspected and turned out to be normal(5). The gastroduodenal artery was also evaluated(6) and no pseudoaneurysm was detected. These two are common arteries to be affected in patients of acute pancreatitis. Other arteries were also inspected and no arterial cause of hemorrhage was identified.