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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
122 ABDOMINAL ULTRASOUND LL Tail of pancreas CBD SV A LRV SMA GB st PV P p B C D ST P E F Figure 5.1 (A) i, ii, Transverse section (TS) showing the normal pancreas. (B) Longitudinal section (LS) oblique to the right of midline, demonstrating the head of pancreas, P, with the common bile duct (CBD) running through it. (C) LS at the midline, demonstrating the body of pancreas. (D) LS angled through the left lobe of the liver towards the tail of pancreas (p). (E) Water in the stomach, ST, provides a window through which to view the pancreas. (F) The main pancreatic duct (arrow) is normally up to 2 mm in diameter (arrow = CBD).
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Abdominal Ultrasound
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Abdominal Ultrasound How, Why and W
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v Contents Contributors Preface ix
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vii Contributors Rosemary Arthur FR
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ix Preface Ultrasound continues to
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ABBREVIATIONS xi MHA MHV MI MPV MRA
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Chapter 1 1 Optimizing the diagnost
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OPTIMIZING THE DIAGNOSTIC INFORMATI
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Chapter 2 17 The normal hepatobilia
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THE NORMAL HEPATOBILIARY SYSTEM 19
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Chapter 3 41 Pathology of the gallb
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PATHOLOGY OF THE GALLBLADDER AND BI
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Page 84 and 85: PATHOLOGY OF THE GALLBLADDER AND BI
Page 92 and 93: Chapter 4 79 Pathology of the liver
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Page 136 and 137: THE PANCREAS 123 the patient’s le
Page 138 and 139: THE PANCREAS 125 Acute pancreatitis
Page 140 and 141: THE PANCREAS 127 E F G Figure 5.3 c
Page 142 and 143: A C DISTANCE = 3.43 CM 5%. 13 Over
Page 144 and 145: THE PANCREAS 131 G H I Figure 5.5 c
Page 146 and 147: THE PANCREAS 133 head of pancreas.
Page 148 and 149: THE PANCREAS 135 pancreatic juice i
Page 150 and 151: Chapter 6 137 The spleen and lympha
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Page 166 and 167: Chapter 7 153 The renal tract CHAPT
Page 168 and 169: THE RENAL TRACT 155 As with any oth
Page 170 and 171: THE RENAL TRACT 157 A B q 0 LRA AO
Page 172 and 173: THE RENAL TRACT 159 junctions of or
Page 174 and 175: THE RENAL TRACT 161 A B Figure 7.5
Page 176 and 177: THE RENAL TRACT 163 carcinomas, the
Page 178 and 179: THE RENAL TRACT 165 the vesicourete
Page 180 and 181: THE RENAL TRACT 167 Table 7.1 Sourc
Page 182 and 183: THE RENAL TRACT 169 A B Figure 7.13
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THE RENAL TRACT 171 Table 7.2 Diffe
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THE RENAL TRACT 173 Ultrasound stil
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THE RENAL TRACT 175 CT is useful fo
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THE RENAL TRACT 177 Xanthogranuloma
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THE RENAL TRACT 179 As with acute t
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THE RENAL TRACT 181 der with increa
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THE RENAL TRACT 183 ● ● Morphol
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THE RENAL TRACT 185 ● ● hydrone
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THE RENAL TRACT 187 A Figure 7.27 A
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THE RENAL TRACT 189 vascular reject
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THE RENAL TRACT 191 B A C Figure 7.
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THE RENAL TRACT 193 computerised ul
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Chapter 8 195 The retroperitoneum a
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THE RETROPERITONEUM AND GASTROINTES
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Chapter 9 215 The paediatric abdome
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THE PAEDIATRIC ABDOMEN 217 A B SPLE
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THE PAEDIATRIC ABDOMEN 219 B A B Fi
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THE PAEDIATRIC ABDOMEN 221 probe de
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THE PAEDIATRIC ABDOMEN 223 When the
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THE PAEDIATRIC ABDOMEN 225 + 78 A 2
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THE PAEDIATRIC ABDOMEN 227 A B C D
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THE PAEDIATRIC ABDOMEN 229 Table 9.
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THE PAEDIATRIC ABDOMEN 231 A LT B C
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THE PAEDIATRIC ABDOMEN 237 mesenter
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THE PAEDIATRIC ABDOMEN 239 E F G Fi
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THE PAEDIATRIC ABDOMEN 241 system i
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Chapter 10 The acute abdomen 243 CH
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THE ACUTE ABDOMEN 245 scan of the p
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THE ACUTE ABDOMEN 247 LIVER LS GB S
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THE ACUTE ABDOMEN 249 D A RT B C E
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THE ACUTE ABDOMEN 251 17. Patlas M,
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Chapter 11 253 Interventional and o
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INTERVENTIONAL AND OTHER TECHNIQUES
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275 Bibliography and further readin
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277 Index A Abdomen, acute gastroin
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INDEX 279 Continuous ambulatory per
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INDEX 281 Intravenous urography (IV
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INDEX 283 Phrygian cap, 29 Pneumobi
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