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APFCs that persist for more than four weeks may organize into homogeneous fluid collections surrounded by a well‐defined wall (Figure 3.2). These pseudocysts are thought to arise from leakage of amylase‐rich pancreatic juice from the main pancreatic duct or its side branches. Pancreatic pseudocyst formation after an episode of AP is a rare event. Most well‐defined collections are composed not just of pancreatic fluid, but rather a mixture of necrotic solid/liquid tissue and should be termed “walled‐off necrosis” (defined in a subsequent section). Pseudocysts that remain sterile and asymptomatic do not require treatment.

Figure 3.1 CECT showing acute interstitial edematous pancreatitis with acute peripancreatic fluid collection (APFC) in the lesser sac and the left anterior pararenal space (arrows indicate borders of APFC). The pancreatic parenchyma (stars) enhances completely, indicating absence of parenchymal necrosis.

Source: courtesy of Peter A. Banks.

Figure 3.2 CECT showing a pancreatic pseudocyst more than four weeks after an episode of acute interstitial edematous pancreatitis. Note the round homogeneous fluid collection surrounded by a well‐defined wall (arrows indicate border of pseudocyst). The pancreatic parenchyma (stars) enhances completely, indicating absence of parenchymal necrosis.

Source: courtesy of Peter A. Banks.