Diagnostic ultrasound ( PDFDrive )

232 PART II Abdominal and Pelvic Sonography
CT is superior to sonography in detecting calciications and
ductal dilation. Calciications are oten made much more conspicuous
on ultrasound images by looking for the color comet-tail
artifact, also known as the “twinkling artifact” 99,100 (Fig. 7.49;
see also Fig. 7.48B and Video 7.5).
Areas of increased and decreased echogenicity are related to
the efects of patchy ibrosis. hese focal areas of altered echogenicity
are oten subjective and diicult to appreciate.
Pseudocysts
Pseudocysts are more common in patients with chronic (20%-
40%) than with acute (5%-16%) pancreatitis (Figs. 7.50 and 7.51,
Video 7.6). 74 Pseudocysts may present with various shapes, contain
necrotic debris (Fig. 7.52), hemorrhage (≈5%) 72 (Fig. 7.53), or
even have a completely solid pattern. 8
FIG. 7.47 Dilated Pancreatic Duct and Branch Duct Calciications.
Ductal calciication is a hallmark of chronic pancreatitis. Transverse
sonogram shows many branch duct stones.
Portal and Splenic Vein Thrombosis
hrombosis of the portal venous system can occur in chronic
pancreatitis because of (1) intimal injury from recurrent acute
PD stones
A
B
C
D
FIG. 7.48 Dilated Pancreatic Duct and Intraductal Stone. (A) Transverse and (B) longitudinal sonograms show chronic pancreatitis with
dilation of the pancreatic duct (PD) and multiple stones in the main duct (arrow). Branch duct stones are manifest as almost conluent, echogenic
parenchymal foci. (C) Transverse gray-scale and (D) color Doppler sonograms show chronic pancreatitis with dilation of the pancreatic duct and
stone in the main duct (arrow). (D) Color comet-tail (aka “twinkle”) artifact at color Doppler imaging can increase stone conspicuity. See also
Video 7.4.