Figure 1b. Gallstones, acute pancreatitis, and gland necrosis in a 47-year-old man with four Ranson grave signs. (a) Early transverse nonenhanced CT scan obtained at the time of admission to the hospital shows a homogeneously enlarged pancreas (solid arrows). There are large heterogeneous peripancreatic fluid collections (open arrows). Gland necrosis cannot be ruled out. K = kidney, L = liver, P = pancreas, Sp = spleen, St = stomach. (b) Follow-up transverse contrast-enhanced CT scan obtained 13 days after a reveals two zones (straight arrows) of liquefied pancreatic necrosis in the neck and tail of the gland. There are residual nodular areas adjacent to the tail of the pancreas, consistent with fat necrosis (curved arrow). P = pancreas. (c) Follow-up transverse contrast-enhanced CT scan obtained 10 days after b reveals development of large pseudocysts (P) in the neck and tail of the pancreas.