Diagnostic ultrasound ( PDFDrive )

CHAPTER 53 The Pediatric Gastrointestinal Tract 1865
such patients to verify the spontaneous resolution of the luid
collection. 177 When the pseudocysts do not adequately resolve,
sonography can be used to suggest suitability for percutaneous
or endoscopic drainage. 178,179
Pancreatic Masses
Tumors of the pancreas are extremely uncommon in children.
he most common primary neoplasms are the benign insulinoma
and adenocarcinoma. 180 Insulinomas are oten diicult to detect
sonographically, but intraoperative sonography has been used
with success. Carcinoma of the pancreas usually appears as an
echogenic or complex pancreatic mass. Pancreatoblastoma is
a rare invasive tumor that is heterogeneous in texture, can encase
vessels, and may metastasize widely. 181-183 Cystic masses of the
pancreas include lymphangioma, solid pseudopapillary tumor
of the pancreas (Fig. 53.51), and the rare congenital pancreatic
cyst. 184,185 Autoimmune pancreatitis can cause focal enlargement
of the pancreas that resembles a mass. 186
Difuse echogenic enlargement of the pancreas can be seen
with nesidioblastosis. his is a tumorlike condition of the
pancreas characterized by difuse proliferation and persistence
of primitive ductal epithelial cells. Nesidioblastosis is oten
associated with hypoglycemia and the Beckwith-Wiedemann
syndrome. Difusely increased echogenicity of the pancreas can
also occur with fatty iniltration in the Shwachman-Diamond
syndrome (Fig. 53.52), but in this condition the pancreas usually
remains normal in size. Fatty replacement of the pancreas also
can occur in children with cystic ibrosis or nonalcoholic fatty
liver disease. Rarely, other types of tumors, such as in leukemia, 187
can iniltrate and enlarge the pancreas.
FIG. 53.50 Pancreatic Pseudocyst in Battered Child. Loculated
luid collection (arrows) in the region of the tail of the pancreas (P).
FIG. 53.52 Pancreatic Enlargement. Lipomatosis associated with
Shwachman-Diamond syndrome. Echogenic enlargement of the pancreas
(arrows).
A
B
FIG. 53.51 Solid Pseudopapillary Tumor of the Pancreas. (A) Ultrasound shows a heterogeneous but predominantly cystic mass in the head
of the pancreas that is only partially visible because of intestinal gas (arrows). (B) Computed tomography shows the partially cystic mass in the
same child (arrow).