Diagnostic ultrasound ( PDFDrive )

CHAPTER 7 The Pancreas 237
A
B
C
FIG. 7.62 Masslike Enlargement of Pancreatic Head Due
to Autoimmune Pancreatitis With Pancreaticobiliary Obstruction.
(A) Transverse sonogram shows dilation of the main pancreatic
duct (arrow). (B) Transverse sonogram shows biliary ductal
dilation. (C) Oblique sonogram shows enlarged and hypoechoic
pancreatic head (arrows).
FIG. 7.63 Mass in Pancreatic Head Due to Autoimmune Pancreatitis.
Transverse intraoperative ultrasound image shows marked
dilation of the main pancreatic duct with obstruction (arrows) due to
involvement of the pancreatic head and neck by autoimmune pancreatitis.
malignancies. 120,121 Ductal adenocarcinoma has a slight male
predominance, most frequently afecting patients 60 to 80 years
of age. he prevalence of pancreatic carcinoma tripled during
the mid-20th century. he mortality rate for patients with
pancreatic cancer has continued to decline since 1975 in men
and has leveled of in women ater increasing from 1975 to 1984. 122
Pancreatic cancer represents only 2% of all cancers but is the
fourth most common cause of cancer death in the United States.
Overall 5-year survival is poor: 2% to 5%. Risk factors include
tobacco smoking (twice the risk as for nonsmokers), obesity,
chronic pancreatitis, diabetes, cirrhosis, and use of smokeless
tobacco. A family history of pancreatic cancer also increases
risk. 123 Rare syndromes associated with increased risk include
Peutz-Jeghers syndrome. 124
he selection of imaging techniques in patients with pancreatic
cancer requires a rational approach based on grim realities about
the disease. Although sophisticated imaging of candidates for
resection consumes much time and efort, it is crucial to remember
that only a few patients have potentially resectable disease at
initial diagnosis. hese are the patients who can potentially beneit
from sophisticated “resectability” studies. Further, even for that
small minority who can be resected with a hope for cure, the