Wu Yingjie, Yi Xiaolei, Xu Maoyong, Liang Hao
Institute of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China.
Provincial Key Laboratory of TCM Diagnostics, Hunan University of Chinese Medicine, Changsha, China.
AME Case Rep. 2025 Jul 8;9:100. doi: 10.21037/acr-25-12. eCollection 2025.
Acute pancreatitis (AP) is a condition with varying severity, ranging from mild to severe, each presenting different prognostic outcomes. Accurate and early assessment of AP severity is crucial for determining appropriate treatment and management. Traditionally, the severity of AP has been evaluated using clinical criteria or imaging, but discrepancies between these assessments can complicate clinical decision-making.
This case report presents two patients with AP, where a mismatch was observed between clinical and imaging severity assessments. In the first case, laboratory tests suggested mild AP, while computed tomography (CT) imaging indicated severe pathology. In contrast, the second case showed severe AP according to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, but the CT imaging only revealed mild findings. This clinical-CT mismatch highlights the need for a comprehensive approach to evaluating AP severity, rather than relying on a single assessment method.
The report introduces the concept of clinical-CT mismatch in the assessment of AP. It emphasizes the importance of integrating clinical scores, such as APACHE II, with imaging findings to provide a more accurate and reliable evaluation of severity. By doing so, clinicians can enhance decision-making and improve management strategies for AP.
急性胰腺炎（AP）病情严重程度各异，从轻度到重度不等，每种情况都呈现出不同的预后结果。准确且早期评估AP的严重程度对于确定恰当的治疗和管理至关重要。传统上，AP的严重程度是通过临床标准或影像学进行评估的，但这些评估之间的差异会使临床决策变得复杂。
本病例报告展示了两名AP患者，在临床和影像学严重程度评估之间观察到了不匹配情况。在第一个病例中，实验室检查提示为轻度AP，而计算机断层扫描（CT）成像显示为严重病变。相反，第二个病例根据急性生理与慢性健康状况评分系统II（APACHE II）评分为重度AP，但CT成像仅显示轻度表现。这种临床与CT的不匹配凸显了采用综合方法评估AP严重程度的必要性，而不是依赖单一的评估方法。
该报告介绍了AP评估中临床与CT不匹配的概念。它强调了将临床评分（如APACHE II）与影像学结果相结合以更准确可靠地评估严重程度的重要性。通过这样做，临床医生可以加强决策制定并改进AP的管理策略。
