Pancreatic ultrasound can be used to assess for pancreatic malignancy, pancreatitis and its complications, as well as for other pancreatic pathology.
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Preparation
Fast the patient to reduce interference from overlying bowel gas, which may otherwise make visualization difficult.
Scanning technique
- 3-6 MHz curvilinear ultrasound transducer
- pancreatic body
- anterior subxiphoid approach with the left lobe of the liver as an acoustic window
- adjuncts to improve visualization
- deep inspiration
- push abdomen out to make a "beer belly" 1
- pancreatic head
- in addition to the above, a right subcostal approach with the transducer angled medially may be useful 1
- pancreatic tail
- can be difficult to visualize
- a water filled stomach may be used as a window 1
- scan coronally in a right lateral decubitus position using the spleen as an acoustic window
Macroscopic appearances
- variable echogenicity
- in young patients, the pancreas is generally less fatty and therefore usually hypoechoic
- with age, fatty replacement of pancreas can result in echogenicity similar to surrounding mesenteric fat
- fatty sparing of the uncinate process
Measurements
- AP diameter
- head: 34 mm
- body: 29 mm
- tail: 32 mm
- length: 12-20 cm
- pancreatic duct: ≤3 mm
