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Chapter 5
121
The pancreas
CHAPTER CONTENTS
The normal pancreas 121
Congenital anomalies of the pancreas 123
Pancreatitis 124
Acute pancreatitis 125
Chronic pancreatitis 128
Malignant pancreatic disease 128
Pancreatic carcinoma 128
Pancreatic metastases 133
Benign focal pancreatic lesions 133
Focal fatty sparing of the pancreas 133
Focal pancreatitis 133
Cysts 134
Trauma of the pancreas 134
Pancreatic transplant 135
THE NORMAL PANCREAS
Ultrasound techniques
Because the pancreas lies posterior to the stomach
and duodenum, a variety of techniques must usually
be employed to examine it fully. Although ultrasound
may still be considered the first line of investigation,
CT, MRI and/or endoscopic retrograde
cholangiopancreatography (ERCP) are frequently
required to augment and refine the diagnosis.
The operator must make the best use of available
acoustic windows and different patient positions
and techniques to investigate the pancreas fully.
The most useful technique is to start by scanning
the epigastrium in transverse plane, using the
left lobe of the liver as an acoustic window. Using
the splenic vein as an anatomical marker, the body
of the pancreas can be identified anterior to this.
The tail of pancreas is slightly cephalic to the head,
so the transducer should be obliqued accordingly
to display the whole organ (Fig. 5.1).
Different transducer angulations display different
sections of the pancreas to best effect:
● Identify the echo-free splenic vein and the
superior mesenteric artery posterior to it. The
latter is surrounded by an easily visible,
hyperechoic fibrous sheath. The pancreas is
‘draped’ over the splenic vein (Fig. 5.1).
● Where possible, use the left lobe of the liver as
an acoustic window to the pancreas, angling
slightly caudally.
● The tail, which is often quite bulky, may
require the transducer to be angled towards