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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.
130 ABDOMINAL ULTRASOUND c A B C D S m LK E F Figure 5.5 (A) The common bile duct, c, is obstructed by a large hypoechoic solid mass at its lower end (calipers), which is a carcinoma in the head of the pancreas. (B) TS through the head of the pancreas, which is swollen by a hypoechoic adenocarcinoma (arrow). (C) The tumour in (B) displays considerable vascularity on colour Doppler. (Note the colour sensitivity setting has been reduced to accommodate this, so eliminating low-velocity flow from the splenic vein.) (D) Tumour in the head of the pancreas (arrows), confirmed by CT. (E) Complex cystic mass in the head of the pancreas, confirmed as a cystadenocarcinoma. (F) A complex mass (m) between the spleen (S) and the left kidney is a large carcinoma of the tail of the pancreas. (Continued)
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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 92 and 93: Chapter 4 79 Pathology of the liver
Page 94 and 95: PATHOLOGY OF THE LIVER AND PORTAL V
Page 134 and 135: Chapter 5 121 The pancreas CHAPTER
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
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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
Page 152 and 153: THE SPLEEN AND LYMPHATIC SYSTEM 139
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
Page 184 and 185: THE RENAL TRACT 171 Table 7.2 Diffe
Page 186 and 187: THE RENAL TRACT 173 Ultrasound stil
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Page 190 and 191: 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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