Diagnostic ultrasound ( PDFDrive )

224 PART II Abdominal and Pelvic Sonography
oten have convex margins, are thicker and more localized, may
cause a mass efect, and sometimes have through transmission
of sound (Fig. 7.29, Video 7.3).
Inlammation is most oten seen ventral and adjacent to the
pancreas in the prepancreatic retroperitoneum (see Figs. 7.22,
7.26, and 7.28), the right and let anterior pararenal spaces, the
perirenal spaces, and the transverse mesocolon. he anterior
pararenal spaces are best seen through a coronal lank approach
(Fig. 7.30). he patient is scanned while in a decubitus position
with the transducer angled to achieve a sagittal scan plane through
the lank. Areas of inlammation within the anterior pararenal
space are oten seen immediately adjacent to the echogenic fat
within the perirenal space. Acute pancreatic inlammation within
the anterior pararenal space occasionally outlines Gerota fascia.
An inlammatory mass (formerly called a phlegmon, although
this term has been abandoned in the newest Atlanta classiication
28 ) may be present (Fig. 7.31; see also Fig. 7.28). he transverse
mesocolon region can be seen well in most patients on longitudinal
scans. Inlammation can extend caudal to the pancreas
and behind the stomach (Fig. 7.32; see also Fig. 7.21) and may
reach the transverse colon. he transverse colon itself may be
diicult to identify; in the transverse plane it lays directly ventral
AC PANC
Ascites and
inflammation
FIG. 7.25 Focal Hypoechoic Area, Acute Pancreatitis. Transverse
image shows heterogeneous pancreas with focal hypoechoic area (arrow).
FIG. 7.27 Inlammation and Ascitic Fluid, Acute Pancreatitis. Transverse
image of right upper quadrant shows acute inlammation in the
anterior pararenal (retroperitoneal) space and the perirenal space (yellow
arrows). Ascites is present in the adjacent subhepatic space (white
arrow). See also Video 7.2.
C
A
B
FIG. 7.26 Inlammation From Acute Pancreatitis. (A) Transverse image shows acute inlammation ventral to the pancreas (yellow arrow)
and ventral to (white arrow) the splenic vein–superior mesenteric vein conluence (C). The pancreas is enlarged and heterogeneous. (B) Transverse
image shows acute inlammation ventral to the pancreas, displacing the stomach (ST) anteriorly. There is an echogenic appearance of the peripancreatic
fat (*) and interspersed small luid collection (arrow).