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Acute Pancreatitis
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Acute Pancreatitis: is an inflammation of the pancreas, causing the escape of pancreatic enzymes from the acinar cells into the surrounding tissues. The majority of the cases of acute pancreatitis stem from diseases of the biliary system and alcoholism. The laboratory analysis of pancreatic enzymes are key to pancreatic destruction.
Sonographic Appearance: When swelling does occur the gland is hypoechoic to anechoic and is less echogenic than the liver because of the increased prominence of lobulations and congested vessels. The borders may be somewhat indistinct but smooth.
Image provided by: Copyright Brigham and Women's Hospital. Used by permission.
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Hemorrhagic Pancreatitis
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Hemorrhagic Pancreatitis: is a rapid progression of acute pancreatitis. In hemorrhagic pancreatitis, there is a diffuse enzymatic destruction of the pancreatic substance caused by a sudden escape of active pancreatic enzymes into the glandular parenchyma. These enzymes cause focal areas of fat necrosis in and around the pancreas, which leads to a rupture of pancreatic vessels and hemorrhage.
Sonographic Appearance: findings depend on the age of the hemorrhage. A well-defined homogeneous mass in the area of the pancreas may be seen with areas of fresh necrosis.
Image provided by: GE
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Phlegmonous Pancreatitis
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Phlegmonous Pancreatitis: is the spreading of diffuse inflammatory edema in soft tissues that may proceed necrosis and suppuration.
Sonographic Appearance: the tissue appears hypoechoic with good-through transmission.
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Pancreatic Abscess
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Pancreatic Abscess: has a low incidence; the condition is related to the degree of tissue necrosis. The majority of patients develop abscess secondary to pancreatitis that develop from postoperative procedures.
Sonographic Appearance: A pancreatic abscess is imaged on ultrasound as a hypoechoic mass with smooth or irregular thick walls, causing few internal echoes; it may be echo-free to echodense.
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Chronic Pancreatitis
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Chronic Pancreatitis: results from recurrent attacks of acute pancreatitis and causes continuing destruction of the pancreatic parenchyma. It generally is associated with chronic alcoholism and hyperlipidemia are more predisposed to chronic pancreatitis.
Sonographic Appearance: may appear as a diffuse or localized involvement of the gland. Echogenicity of the pancreas is increased beyond normal because of fibrotic and fatty changes. The borders are irregular, and the duct may be dilated secondary to stricture or as the result of an extrinsic stone moving from smaller pancreatic duct into a major duct.
Image provided by: By Klaus Mergener, MD and Richard A Kozarek, MD, Best Practice of Medicine Copyright. Gotto, Antonio (ED): DISEASE(tm) General Medicine. Thomson MICROMEDEX, Greenwood Village, Colorado.
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True Pancreatic Cyst
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True Pancreatic Cysts: are microscopic sacs that may be congenital or acquired. Congenital cysts are the result of anomalous development of the pancreatic duct and may be single but are usually multiple and without septation. Acquired cysts are retention cysts, parasitic cysts, or neoplastic cysts. True pancreatic cysts arise from within the gland, usually in the head first, then in the body and tail. They have a lining epithelium, which may be lost with inflammation. The cysts contain pancreatic enzymes or may be found to continuous with the pancreatic duct.
Sonographic Appearance: anechoic, smooth round borders, good thru transmission, posterior enhancement.
Image provided by: Sononino
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Pancreatic Pseudocycts
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Pancreatic Pseudocycts: are always acquired; they result from trauma to the gland or acute or chronic pancreatitis. A pseudocyst may be defined as a collection of fluid that arises from the location of inflammatory processes, necrosis, or hemorrhage.
Sonographic Appearance: appear as well-defined masses with essentially sonolucent, echo-free interiors. The borders are very echogenic, and the cysts usually are thicker than other simple cysts.
Image provided by: GE
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Cystadenoma
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Cystadenoma: is a rare, benign disease found more ofter in females than males. Tiny cysts are found primarily in the body and tail.
Sonographic Appearance: The coarsely lobulated cystic tumors sometimes present sonographically with cysts walls thicker than the mambrane between multilocular cysts.
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Cystadenocarcinoma
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Cystadenocarcinoma: is an uncommon, slow-growing tumor that arises from the ducts as a cystic neoplasm. It is composed of a large cyst with or without septations and has a significant malignant potential. Patients present with epigastric pain or a palpable mass. Metastases arise most commonly in the lymph nodes and liver.
Sonographic Appearance: It is irregular, lobulated cystic tumor with thick cellular walls.
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Adenocarcinoma
Adenocarcinoma: is the most common primary neoplasm of the pancreas. This fatal tumor involves the exocrine protion of the gland and accounts for 95% of all malignant pancreatic tumors. The most frequent site of occurance of in the head of the gland.
Sonographic Appearance: is the loss of the normal pancreatic parenchymal pattern. The lesion represent localized change in the echodensity of the pancreas. The echo pattern is hypoechoic or less dense than the pancreas or liver. The borders become irregular and the pancreas may be enlarged.
Image provided by: GE
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Islet Cell Tumors
Islet Cell Tumors: There are several types of islet cell tumors; they may be functional or nonfunctional. The tumors may be benign adenomas or malignant tumors. Non-functioning islet cell tumors comprise one third of all islet cell tumor, with 92% being malignant.
Sonographic Appearance: are difficult to diagnosis because of their small size. The greatest success is when they are located in the head of the pancreas.
Image provided by: Medscape
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Metastic Disease of the Pancreas
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Metastic Disease of the Pancreas: spreading of cancer from one part of the body to another.
Sonographic Appearance: An intrabdominal lymphoma may cause a hypoechoic mass in the pancreas. The enlarged nodes appear hypoechoic and well defined.
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Pancreatic Head Tumor
Pancreatic head tumor: a mass within the pancreas may cause dilation of the biliary tree because the common bile duct passes through the pancreatic head and might become compressed.
Sonographic Appearance:
Image provided by: Medison
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