9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

A
C
DISTANCE = 3.43 CM
5%. 13 Over 70% of patients die from hepatic metastases
within 3 years postoperatively. 14
Differential diagnoses of pancreatic masses must
always be considered (Table 5.2); focal lesions in
the pancreas may represent inflammatory rather
than malignant masses. An ultrasound-guided
biopsy is sometimes useful in establishing the presence
of adenocarcinoma if the biopsy is positive,
but the sensitivity of this procedure is relatively
low. 15 The value of a negative biopsy is dubious
because of the inflammatory element surrounding
many carcinomas.
2
4
6
8
10
12
THE PANCREAS 129
B
D
Endosonography-guided biopsy, however, has
high sensitivity and specificity for diagnosing pancreatic
cancer, and is also useful in patients with a
previous negative biopsy in whom malignancy is
suspected. 16 ERCP may also be used to insert a
palliative stent in the common bile duct, to relieve
biliary obstruction.
The detection of a pancreatic carcinoma by
ultrasound is usually followed by a CT scan for
staging purposes as this will demonstrate invasion
of peripancreatic fat, vascular involvement and
lymphadenopathy. 16
Figure 5.4 (A) Chronic pancreatitis in a patient with alcoholic cirrhosis; the pancreas is hyperechoic compared with
the liver and has a heterogeneous texture with a lobulated outline. (B) Calcification of the pancreas in hereditary
pancreatitis. (C) A cycle of acute on chronic pancreatitis, with pseudocysts and considerable calcification. (D) A stone
(arrow) is obstructing the main pancreatic duct.