Solid epithelial neoplasm from ductal epithelium of exocrine pancreas

US often 1st-line imaging to evaluate obstructive jaundice and level of obstruction

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  Not as sensitive as CT or MR for mass or staging

Hypoechoic, infiltrative mass or isoechoic mass with subtle focal contour deformity

Variable size

Pancreatic ductal dilation and bile duct dilation

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  Double duct sign: Dilation of both ducts

Diffuse glandular tumor involvement can be difficult to differentiate from acute pancreatitis

Atrophy or pancreatitis proximal to pancreatic ductal obstruction

Typically hypovascular, but color Doppler may be helpful in assessing vascular encasement or venous obstruction

Displacement/encasement of adjacent vascular structures, determines resectability (as well as metastases)

Liver and regional lymph node metastases

Ascites due to peritoneal metastasis

Endoscopic US used to guide biopsy

Chronic pancreatitis

Other primary pancreatic tumors

Metastases

Lymphoma

Mean at onset: 55 years; peak: 7th decade; M:F = 2:1

Usually asymptomatic until late in course: Obstructive jaundice, weight loss

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  Pancreatic head tumor presents with obstructive jaundice

  
  
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  Body or tail tumor presents later with weight loss

Most commonly presents with distant metastases (~ 65%); least likely to present with tumor confined to pancreas

Poor overall prognosis; 5-year survival rate of ~ 5%

Better long-term survival through complete resection

Look carefully at site of transition of dilated bile or pancreatic duct to normal caliber