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Revised definitions of morphological features of acute pancreatitis

1. Interstitial edematous pancreatitis

Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis
Contrast-enhanced computed tomography criteria:

Pancreatic parenchyma enhancement by intravenous contrast agent
No findings of peripancreatic necrosis

2. Necrotizing pancreatitis

Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis
Contrast-enhanced computed tomography criteria:

Lack of pancreatic parenchymal enhancement by intravenous contrast agent, and/or
Presence of findings of peripancreatic necrosis (refer to below–acute peripancreatic fluid collection and walled off necrosis)

3. Acute peripancreatic fluid collection (APFC)

Peripancreatic fluid associated with interstitial edematous pancreatitis with no associated peripancreatic necrosis. This term applies only to areas of peripancreatic fluid seen within the first four weeks after onset of interstitial edematous pancreatitis and without the features of a pseudocyst.
Contrast-enhanced computed tomography criteria:

Occurs in the setting of interstitial edematous pancreatitis
Homogeneous collection with fluid density
Confined by normal peripancreatic fascial planes
No definable wall encapsulating the collection
Adjacent to pancreas (no intrapancreatic extension)

4. Pancreatic pseudocyst

An encapsulated collection of fluid with a well-defined inflammatory wall usually outside the pancreas with minimal or no necrosis. This entity usually occurs more than four weeks after onset of interstitial edematous pancreatitis to mature.
Contrast-enhanced computed tomography criteria:

Well circumscribed, usually round or oval
Homogeneous fluid density
No non-liquid component
Well-defined wall (ie, completely encapsulated)
Maturation usually requires >4 weeks after onset of acute pancreatitis; occurs after interstitial edematous pancreatitis

5. Acute necrotic collection (ANC)

A collection containing variable amounts of both fluid and necrosis associated with necrotizing pancreatitis; the necrosis can involve the pancreatic parenchyma and/or the peripancreatic tissues
Contrast-enhanced computed tomography criteria:

Occurs only in the setting of acute necrotizing pancreatitis
Heterogeneous and non-liquid density of varying degrees in different locations (some appear homogeneous early in their course)
No definable wall encapsulating the collection
Location–intrapancreatic and/or extrapancreatic

6. Walled-off necrosis (WON)

A mature, encapsulated collection of pancreatic and/or peripancreatic necrosis that has developed a well-defined inflammatory wall. WON usually occurs >4 weeks after onset of necrotizing pancreatitis.
Contrast-enhanced computed tomography criteria:

Heterogeneous with liquid and non-liquid density with varying degrees of loculations (some may appear homogeneous)
Well-defined wall, that is, completely encapsulated
Location–intrapancreatic and/or extrapancreatic
Maturation usually requires four weeks after onset of acute necrotizing pancreatitis

Reproduced with permission from: Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis – 2012: revisions of the Atlanta classification and definitions by international consensus. Gut 2013; 62:102. BMJ Publishing Group Ltd. Copyright © 2013.

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