RADIOLOGY: HEPATOBILIARY: Case# 32841: CALCIFIC PANCREATITIS AND CIRRHOSIS, FATTY CHANGE. 47 year old female with a long history of alcohol abuse. The liver has a cirrhotic configuration with enlargement of the caudate and left lobes. The liver is markedly heterogeneous is attenuation. The spleen is moderately enlarged. Multiple venous collaterals (gastrohepatic, gastrosplenic, mesenteric) are present. A small amount of ascites is identified. The entire pancreas is extensively calcified. Very little residual panceatic tissue remains. Diffuse low attenuation surrounds the pancreas and extends into the mesentery. Chronic pancreatitis is now believed by many not to be merely the sequelae of repeated bouts of acute pancreatitis, but rather a separate disease entity with its own natural history. Chronic pancreatitis is usually due to related to long-term alcohol abuse. Other etiologies include hyperlipidemia, hyperparathyroidism, cholelithiasis and cystic fibrosis. In addition, a form of autosomal dominant familial pancreatitis known as hereditary pancreatitis can result in chronic calcific pancreatitis. CT findings in chronic pancreatitis include main pancreatic duct dilatation (66%), parenchymal atrophy (54%), calcifications (50%), pseudocysts (34%), focal gland enlargement (32%), biliary ductal dilatation (29%), and pancreatic fat/fascia abnormalities (16%). The pancreas may appear normal in 7% of cases. Irregular pancreatic duct dilatation with a duct width to total gland width ratio of less than 0.5 favors chronic pancreatitis. Smooth or beaded pancreatic ductal dilatation is associated with carcinoma.