spleen and pancrease

Pancreas and Spleen

亞東醫院急診醫學部孫仁堂醫師

2011年8月6日星期六

Pancrease

• Normal picture

➡ vascular marker

• Pathological pancrease

➡inflammation- acute/chronic pancretitis

➡tumor


When


When

• Jaundice

• abdominal pain

• Not suitable for CT

- Pregnant, contrast allergies.....


Anatomy

• Retroperitoneal

• Post to stomach

• Water

• Duodenal C-loop

• Vascular


Transverse view


Vessel of pancreas

• Splenic vein

• Post to body and tail

• Cobra head

• Pancreatic mass located anterior to splenic vein


SMV

• Parallel and right of SMA

• Landmark of pancrease

- Head is lateral

- Neck is anterior

- Uncinate is postierior


Sagittal view


Main portal vein and IVC

• Pancreatic head inferiorly

• Marker for the head

• 4cm in length


SMA

• Anterior to aorta

• Echogenic mesenteric fat

• Marker for the body

• Shallow angle


Splenic artery

• Along with cranial border of body and tail

• Tortuous course


Pitfall


Normal size

• Head: <4cm

• Body: <2cm

• Tail: <2.5cm


Sagittal view


Vascular marker


Pancreatic duct

• Size<2mm

• Center of gland


Uncinate process

• Dorsal and ventral anlage that fuse

• Different fat content and echogenicity


Pathologic

• Inflammation

- Acute

- Chronic

- Complication

• Pancreatic tumor


Acute pancreatitis


Acute pancreatitis

• Biliary pancreatitis

• Complication

• Fluid collection

• Unsuspected cases


Acute pancreatitis

• 20% is normal

• Diffuse and focal

• Hypoechoic


Acute pancreatitis:focal

• Mimic carcinoma

• Usually in head


Complication

• Pancreatic infection and abscess

• Pseudocyst formation

• Pseudoaneurysm, thrombosis


Acute pancreatitis


Complication


Pseudocyst

• 90% of cystic mass

• Encapsulated, fluid collection

• Multiple

• Calcified

• Complication


Complication of pseudocyst

Infection

Rupture

Hemorrhage


Chronic pancreatitis

• Calcification

• Heterogeneous

• Irregular dilated duct and outline

• Decrease size

• Pseudotumor penetrating duct sign


Pancreatic tumor

• Pancreatic carcinoma

• Islet cell tumor

• Cystic tumor


Pancreatic cancer

• Head(60%), body and tail(40%)

• Solid, focal, irregular, hypoechoic mass

• Vessel invasion, encasement

• P duct, bile duct dilation


Pancreatic carcinoma


Pancreatic tail carcinoma


1. Microcystic adenoma(serous)

2. Macrocystic adenomas(Mucinous)

3. Intraductal paipillary mucinous neoplasm

* Mucinous tumors have malignant potential

Cystic tumor


Microcystic adenoma

• Smooth margin

• Heterogenic


Macrocystic adenoma


Cystic tumor


IPMN


Islet cell tumor

• Insulinoma, gastrinoma, VIP-oma...

• Small homogenous hypoechoic tumor

• EUS Sensitive and FNA biopsy


Pancreatic trauma


Spleen


Spleen

• Normal picture

• Post. axillary line

• Accessory spleen

• Splenomegaly

• Splenic cystic lesion

• Splenic solid lesion


Longitudinal

Splenic hilum


Longitudinal

Lt Kidney

Adrenal

Spleen


Normal spleen

• Homogeneous

• Moderate echogenic

• Wandering spleen


Splenomegaly

• Lymphoproliferative disease (lymphoma)

• Portal hypertension

• Infectious (mononucleosis, AIDS)

• Infiltrative (Gaucher’s)


Size

• A>10cm & B>5cm

• A*B >30

• A*B>20A

B


Accessory spleen

• Isoechoic, round, small mass

• Splenic hilum

• 10% patient

• Solitary or multiple


Cystic mass

• Cyst

• Hematoma

• Abscess

• Pseudoaneurysm


Cyst

• Primary: rare

• Secondary old trauma pseudocyst

• Hemorrhage, infection


Trauma

• Irregular hyperechoic or hypoechoic

• Subcapsular hematoma dopplar can help

• Perisplenic fluid

• Contrast ultrasound


Splenic laceration


Subcapsular hematoma


Contrast ultrasound


Infection

• Usually secondary causeIE, septicemia......

• Bacterial: hypoehcoic or complex with irregular margin

• Fungal: target sign, small(1cm)

• Granulomatous: calcification


Microabscesses

• Target lesion, bull’s eye lesion

• Fungal: candidiasis


Candidiasis


Bacterial abscess


Psuedoaneurysm

• Trauma or pancretitis

• Dopplar


Solid masses

• Infarct

• Hemangioma

• Lymphoma

• Metastasis


Gamm-Gandy bodies

• Hyperechoic without PAS

• Siderotic nodule

• Splenomegaly

• Portal hypertension

• Sickle cell anemia

• PCP infection


Infarct

• Most common focal lesion

• Peripheral, wedge shape hypoechoic lesion

• Septic emboli

• Thrombosis of splenic vessel


Calcification

• Hyperechoic with PAS

• TB or histoplasmosis


Hemangioma

• Rare

• Hyperechoic mass

• Spleen size usually normal


Lymphoma

• Splenomegaly

• diffuse or focal

• Hypoechoic

• LAP


Metastasis

• Lung, breast, melanoma

• May be target lesion


Cystic metastasis


Thank you


splenic granuloma

• Hyperechoic lesion

• Tiny shadow

• TB?


spleen and pancrease

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