Pancreas

Chapter 4. Pancreas

Patient Preparation

• Fasting for 6 to 12 hours; emergency examinations may be done without fasting.

Equipment and Technical Factors

• A curved linear multihertz transducer is preferred.

• The pancreas is more echogenic than the liver in the adult patient, and isoechoic to less echogenic in pediatric age groups; images should clearly demonstrate the relational vascular landmarks.

• The pancreas generally decreases in size and increases in echogenicity with age.

• Color Doppler imaging may be used to distinguish between a vessel and a bile duct.

Imaging Protocol

• Longitudinal axis images (transverse scan plane) through the head, neck, body and tail (if possible) should be obtained; these images will also include the great vessels, portal vein, and splenic vein, and artery.

• Transverse axis images (sagittal scan plane) of the head/uncinate process, neck, body, and tail should be obtained; these images will also include the great vessels, portal vein, and splenic vein and artery.

• The relationship of the CBD and pancreas head in longitudinal and transverse axes should be demonstrated.

• Measurements of the pancreas may be included; measurements must be done when pathology is detected.

• Semiupright to upright patient positions, “belly-out” breathing technique, or oral ingestion of water or contrast agent may improve visualization of the pancreas (water or contrast may be contraindicated in some patients).

Sonographic Measurements

Pancreas

Measurements are performed in the anterior to posterior dimension perpendicular to the longitudinal axis of the pancreas:

Head: <3.0 cm (range: 2.0−3.5 cm)

Neck: 1.0−2.0 cm

Body: <2.5 cm (range: 1.2−3 cm)

Tail: <2.5 cm (range: 1.0−2.8 cm)

• Length: 12−15 cm (generally not measured sonographically)

• Main pancreatic duct (MPD) lumen diameter: <2 mm

Pancreas
Sonographic Finding(s)	Clinical Presentation	Differential Diagnosis	Next Step
Patient is focally tender when scanning over a pancreas with normal sonographic appearance Pancreas less echogenic than normal for age Pancreas less echogenic than normal for age and demonstrates focal or diffuse enlargement (>3.0 cm AP head or tail) With or without MPD enlargement With or without pseudocyst formation	Pain (possibly severe) Fever Fatty stool History of ERCP or pancreatic cancer Labs: elevated serum amylase (within 24 h) and lipase (within 72–94 h), direct bilirubin, ALP, WBC Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related posts: Biliary System Fundamentals Male Pelvis Breast Pediatric Studies Uterus, Placenta, Umbilical Cord, and Fluid Stay updated, free articles. Join our Telegram channel Tags: Pocket Guide to Sonography Sep 17, 2016 \| Posted by admin in GENERAL RADIOLOGY \| Comments Off on Pancreas Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access