Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walled-off necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging (MRI) performs better than computed tomography (CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis (seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis (solid debris delineation) and management (drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with (18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.

The dynamics of OF in the first week of SAP predicts the clinical course and outcome. Persistent and deteriorating OF indicates a poor outcome.

This prospective case series clinically validated the 4-category classification of AP severity.

Hypotension in the first week of AP and APACHE II score predict development of IN.

A 6-year-old boy presented to the emergency department with increasing fatigue and abdominal distention that had worsened over several weeks. Numerous visits to immediate care clinics had resulted in various diagnoses such as pharyngitis, otitis, and viral syndrome. He was previously healthy, but was learning disabled. He had been incorrectly labeled as autistic by a chiropractor, who recommended vitamins and a caffeinated energy drink that was purported to improve concentration and academic performance.On examination he was afebrile but appeared fatigued. Positive findings included abdominal distention and hepatosplenomegaly. An abdominal ultrasound confirmed an enlarged liver and spleen, and he underwent the following liver tests: alanine aminotransferase (ALT) 275 U/L, aspartate aminotransferase (AST) 707 U/L, g-glutamyl transferase 155 U/L, and total bilirubin 1.2 mg/dL. Albumin was low at 2.7 g/dL. He was transferred to our center for further evaluation and management.Additional laboratory reports included immunoglobulin G of 1600 mg/dL, anti-nuclear antibody positive, and anti-smooth muscle antibody elevated at 45 U. His hemoglobin was low at 10 g/dL but he had no hemolysis. Ceruloplasmin was normal at 24 mg/dL, and urine copper was mildly elevated at 212 mg/d. A penicillamine challenge test raised the 24-hour urine copper to 1600 mg/d. Liver biopsy demonstrated extensive fibrosis, and special staining with rhodamine was positive for copper (Fig. 1, which includes 4 stains: H and E, trichrome, reticulin, and rhodamine). A careful history for copper exposure was taken and found to be unremarkable, so his dry copper weight of 1400 mg/g of liver tissue was considered diagnostic for Wilson disease (WD). He was started on chelation therapy with trientene and zinc. Within 1 week he developed acute liver failure with bilirubin rising to 50 mg/dL and international normalized ratio rising to 6. He received a liver transplant within 72 hours from listing and has done well postoperatively.The patient's 3 siblings were screened for WD with ceruloplasmin and 24-hour urine copper. His fraternal twin brother had mild elevation of ALT and AST, normal ceruloplasmin, and elevated 24-hour urine copper, so he underwent liver biopsy. He also had abundant copper staining and a dry copper weight of 3020 mg/g of liver tissue. His liver biopsy was negative for fibrosis or inflammation (Fig. 2, which includes 4 stains: H and E, trichrome, reticulin, and rhodamine). He has responded to chelation with penicillamine and remained stable for 12 months.Genetic testing was obtained on the index case with sequencing of the entire ATP7B gene. There were no mutations found in