Diagnostic ultrasound ( PDFDrive )

240 PART II Abdominal and Pelvic Sonography
A
B
FIG. 7.67 Eccentric Pancreatic Ductal Adenocarcinoma. (A) Transverse sonogram shows that pancreatic carcinoma may cause considerable
ibrosis (desmoplastic reaction) and obstruct adjacent ducts. Thus even this uncinate process mass (arrow), which appears somewhat distant from
the dilated pancreatic duct (calipers) and common bile duct (CBD), can cause ductal obstruction. (B) Coronal contrast-enhanced computed tomography
conirms that the uncinate process mass (arrow) is eccentric to the obstructed pancreatic duct (PD). CBD obstruction has been relieved by stenting.
TRANS
PANC CA
PD
D
LRV
FIG. 7.68 Heterogeneous, Mainly Echogenic Pancreatic Carcinoma.
Transverse sonogram shows tumor obstructing the extrahepatic
bile duct. Increased echogenicity (white arrow) is unusual in pancreatic
ductal adenocarcinoma. This heterogeneous cancer causes a double-duct
sign with pancreatic duct dilation (PD). The intrahepatic duct dilation is
manifest as dilated minor ducts (yellow arrows).
FIG. 7.69 Cystic Area in Pancreatic Ductal Adenocarcinoma. Transverse
sonogram shows a complex mass in the pancreatic head. Small,
intratumoral cystic areas (arrow) are present in about 10% to 15% of
pancreatic cancers. These cysts can be seen in chronic pancreatitis as
well, rendering this feature unhelpful in differentiating the two conditions.
D, Duodenum; LRV, left renal vein. See also Video 7.7.
TRANS
A
B
FIG. 7.70 Pancreatic Ductal Adenocarcinoma Causing “Obstructive Pseudocyst.” (A) Transverse sonogram reveals a subtle cancer in the
body of the pancreas (yellow arrows) with a pseudocyst peripheral to the mass (white arrow). (B) Computed tomography image at a similar level
shows identical indings.