Abstract
BACKGROUND: Acute pancreatitis (AP) is a condition with varying severity, ranging from mild to severe, each presenting different prognostic outcomes. Accurate and early assessment of AP severity is crucial for determining appropriate treatment and management. Traditionally, the severity of AP has been evaluated using clinical criteria or imaging, but discrepancies between these assessments can complicate clinical decision-making. CASE DESCRIPTION: This case report presents two patients with AP, where a mismatch was observed between clinical and imaging severity assessments. In the first case, laboratory tests suggested mild AP, while computed tomography (CT) imaging indicated severe pathology. In contrast, the second case showed severe AP according to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, but the CT imaging only revealed mild findings. This clinical-CT mismatch highlights the need for a comprehensive approach to evaluating AP severity, rather than relying on a single assessment method. CONCLUSIONS: The report introduces the concept of clinical-CT mismatch in the assessment of AP. It emphasizes the importance of integrating clinical scores, such as APACHE II, with imaging findings to provide a more accurate and reliable evaluation of severity. By doing so, clinicians can enhance decision-making and improve management strategies for AP.