Pancreas

Acute Pancreatitis

  • Pancreas is one of the fattier organs in the body

  • Typically the pancreas appears hyper-echoic (bright) on ultrasound because it contains a lot of fat. (remember in hepatic steatosis the liver also appears bright on US). So in acute pancreatitis the pancreas will appear hypo/iso-echoic (dark) as there will be edema within and around the pancreas which makes it dark as fluid appears dark on US.

Pancreas US

  • Typically bad to diagnose anything

  • Pancreatic duct dilatation

    • Pancreatic duct > 3mm

      • Needs follow up CT or MRCP

    • Double duct sign

      • Abnormally dilated pancreatic and biliary duct = no bueno = concern for mass —> get CT

  • Pncreatitis

    • US typically just to look for cause, specially a stone

    • Pancreas will have decreased echogenicity than normal due to the edema - pancreas normally very echogenic

    • Pay close attention to portal and splenic vein for thrombosis

    • Pancreatic necrosis —> pancreas will appear hyperechoic

Pancreatic Neuroendocrine Tumors

  • Masses that arise from pancreatic endocrine cells (islets of langerhans cells)

  • Mets to liver if they metastasize

  • Types

    • Insulinoma (most common)

    • Gastrinoma

    • Non-functioning

Solid and Pseudopapillary Neoplasma (SPEN)

  • Well defined

  • Typically in tail of pancreas

  • Hypoechoic on US

  • Solid mass with hemorrhagic and necrotic focus

  • Low risk but still some risk of malignancy

  • Women, <35

Pancreatic Masses

Serous Cystadenoma

  • Innumerable microcysts in a mass (Described as honeycomb)

  • >60 years old typically

  • Prefer head of pancreas

  • No ductal dilatation

  • Benign, no need for treatment

Pancreatic Neuroendocrine Tumor

  • Look for hypoglycemia

Mucinous Cystadenoma

  • Less than 6, large (2cm+) cystic lesions in a mass

  • Middle aged women

  • Prefer tail of pancreas

  • No ductal dilatation

  • Peripheral calcifications possible

Cystic Fibrosis

  • Typically atrophic fatty pancreas

  • Can also have numerous pancreatic cysts sometimes with calcs

    • But in a young person they should not have chronic pancreatitis already

  • Biliary manifestations

    • Micro-gallbladder, I mean really fucking small

    • PSC appearance of the biliary ducts

  • Distal intetsinal obstruction

  • Absence of seminal vesicles in males

Other

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