Diagnostic ultrasound ( PDFDrive )

212 PART II Abdominal and Pelvic Sonography
A
B
FIG. 7.3 Normal Pancreatic Neck and Body. (A) Transverse image of pancreatic body. The “neck” of the pancreas (arrow) is that part of the
body ventral to the superior mesenteric artery and portosplenic conluence. (B) Role of technique in sonographic visualization of the pancreas.
Transverse image of region of pancreas shows poor visualization of the gland (arrow); water was administered orally and patient placed in the
upright position to achieve the image shown in (A). LK, Left kidney; ST, stomach.
A
B
FIG. 7.4 Pancreatic Body and Tail. (A) Transverse image of the pancreatic body and tail obtained by positioning the transducer to the right of
the midline and angling back toward the left. (B) In another patient with chronic pancreatitis, the transverse view shows the dilated pancreatic
duct with scattered calciications extending to the end of the duct in the pancreatic tail (arrow). LK, Left kidney.
(GDA) and the pancreaticoduodenal arcade anterolaterally (Fig.
7.5). he pancreatic head is usually directly ventral to the IVC.
Cephalic to the pancreas, the IVC is adjacent to the portal vein;
this location is the entrance into the lesser peritoneal sac, the
epiploic foramen (foramen of Winslow).
he uncinate process (or uncinate) is a portion of the caudal
pancreatic head that wraps around behind the SMA and SMV,
ending in a point oriented medially. he uncinate process is
medial and dorsal to the SMA and SMV (Fig. 7.6; see also Fig.
7.1B). he GDA is a landmark for the ventrolateral pancreatic
head; the GDA courses between the pancreas and the second
portion of the duodenum (Fig. 7.7).
Another useful vascular landmark for the pancreatic
head and uncinate process is the gastrocolic trunk (GCT).
Several splanchnic veins variably join to form the GCT.
hese oten include the right or middle colic vein, right gastroepiploic
vein, and pancreaticoduodenal veins. he GCT
enters the right side of the SMV just anterior to the pancreatic
head, thus serving as a ventral landmark for the uncinate
process 4 (see Fig. 7.1).
he let lateral decubitus position is best to see the pancreas
adjacent to the duodenum. In the let lateral decubitus position,
scan in inspiration, and use the gallbladder or liver to either side
of the gallbladder to view the rightmost portion of the pancreas