우선 췌장농양은 벽을 형성에서 안에 고름이 있느지가 중요합니다.

그림설명 : A 66-year-old woman with a pancreatic abscess. A 9-cm irregular thick-wall collection with a thick septation is seen in the head of pancreas. Mean CT score was 0.5. This patient was successfully managed by endoscopic drainage alone 

그에 반해 감염성 이자괴사는 이러한 벽 없다는 점이 특징입니다.

하지만 이 둘 모두 심한 급성 췌장염의 합병증이고 주로 공기층이 동반될수도 있고 또한 주변으로 액체저류가 보일 수 있습니다.

국시에서 영상소견만으로 구분하라는 문제는 나오지 않습니다.

주로 임상소견과 같이 종합적으로 판단해야 합니다.

특히 감염성 이자괴사는 주로 패혈증과 같이 동반되는 경우가 많다고 합니다.

이둘의 전반적인 차이점을 알고 싶다면 다음을 참고하시면 되겠습니다.

Abstract

Local septic complications in acute pancreatitis need to be exactly characterized and defined in order to develop improved concepts for their prevention, early diagnosis, and therapy. While up to now all local septic complications have been termed abscesses, the present study for the first time delineates the morphologic, clinical, and laboratory criteria needed to distinguish between two separate clinical entities: the infected necrosis (IN) and the pancreatic abscess (PA). IN is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue, but without any significant pus collections. On the other hand, the morphologic substrate of PA is a localized collection of pus surrounded by a more or less distinct capsula. IN becomes clinically evident during the early phase of acute pancreatitis (AP). The patients with IN present both the signs of sepsis and the laboratory findings of AP. Thus in these patients the most fulminant course of AP is observed; 51.8% and 35.7% of them have pulmonary or renal insufficiency, respectively. The mortality of the patients with IN is high and amounts to 32.1%. Pancreatic abscess, on the other hand, does not develop before the fifth week after onset of symptoms and after subsidence of the acute phase of pancreatitis. In these patients laboratory signs of AP-like amylasemia, hypocalcemia, hyperglycemia, and rise of LDH are rarely observed. Corresponding to the lack of pathophysiologic effects of AP per se, pulmonary and renal insufficiencies occur in only 33.3% and 16.7%, respectively, and mortality in these patients is 22.2%. While an abscess may readily be identified by computed tomography, the differentiation between IN and non-IN can be very difficult.

출처 : Bittner R, Block S, Büchler M, Beger HG. Pancreatic abscess and infected pancreatic necrosis. Different local septic complications in acute pancreatitis. Dig Dis Sci. 1987 Oct;32(10):1082-7. doi: 10.1007/BF01300192. PMID: 3308374.