Diagnostic ultrasound ( PDFDrive )

1864 PART V Pediatric Sonography
A
B
C
FIG. 53.48 Cystic Masses. (A) Mesenteric
lymphangioma with a multiloculated appearance
(arrows). (B) Another child with a large
lymphangioma involving the omentum. (C)
Teratoma. Large, septated abdominal cyst
with an internal mass of fat and a few small
calciications.
A
B
FIG. 53.49 Pancreatitis. (A) Child with pancreatic enlargement secondary to viral pancreatitis (arrows). (B) Chronic pancreatitis in a 7-year-old
child with pancreas divisum shows atrophic pancreas and a dilated pancreatic duct (arrows).
ibrosis). With cystic ibrosis, precipitation or coagulation
of secretions in the small pancreatic ducts leads to ductal
concretions and obstruction. Distention of the ducts and
acini leads to degeneration and replacement by small cysts.
his ductal obstruction, along with atrophy of glandular elements
and ensuing ibrosis, creates increased echogenicity of
the pancreas 173-175 (see Fig. 53.49B). he gland is oten small,
and calciications may be seen as punctate, echogenic foci
within the hyperechoic pancreas. A similar appearance may
be found in patients with hereditary autosomal dominant
pancreatitis. 176
Peripancreatic luid collections oten accompany acute
pancreatitis, but such collections are not considered pseudocysts
until they become persistent and are surrounded by a well-deined
echogenic wall (Fig. 53.50). Many pancreatic pseudocysts are
now treated conservatively, and sonography is useful for following