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1

Inflammation of the pancreas may be chronic or acute

Pancreatitis

2

Sudden onset of moderate to severe abdominal pain with radiation to back
Nausea and vomiting
History of gallstones (localized) or alcoholism
Mild fever
Increased pancreatic enzymes in blood (amylase, lipase)
Leukocytosis (increased white blood cells)
Abdominal distention

Acute pancreatitis clinical findings

3

Ranges from normal size to focal/diffuse enlargement
Hypoechoic texture (edema)
Borders distinct but irregular
Enlargement of head causes depression on inferior vena cava
40% to 60% have gallstones
Pancreatic duct may be enlarged
Parapancreatic fluid collections

Acute pancreatitis sonographic findings

4

Hemorrhagic pancreatitis
Pancreatic neoplasm
Lymphoma
Retroperitoneal neoplasm

Acute pancreatitis differential considerations

5

Decreased Hematocrit and serum calcium level
Intense, severe pain radiating to back, with subsequent shock and ileus
Hypotension despite volume replacement, with metabolic acidiosis and adult respiratory distress syndrome

Hemorrhagic pancreatitis Clinical findings

6

Depends on age of hemorrhage
Well defined homogeneous mass in area of pancreas

Hemorrhagic pancreatitis Sonographic findings

7

Chronic hemorrhage

Hemorrhagic pancreatitis differential considerations

8

See Acute pancreatitis

Phlegmonous pancreatitis clinical findings

9

Hypoechoic, ill defined mass

Phlegmonous pancreatitis sonographic findings

10

Chronic Hemorrhage

Phlegmonous pnacreatitis differential considerations

11

Fever, chills
Increased leukocytosis
Hypotension
Tender abdomen

Pancreatic abscess clinical findings

12

Hypoechoic mass with smooth borders
Thick walls
Echo-free to echogenic

Pancreatic abscess sonographic findings

13

Acute pancreatitis
chronic pancreatitis

Pancreatic abscess differential considerations

14

Seer abdominal pain radiating to back
Malabsorption
Fatt y stools
Signs of diabetes
Weight loss Jaundice
Incrseaed amylase and lipase

Chronic pancreatitis clinical findings

15

Gland is small and fibrotic
Irregular borders
Mixed echogenicity
Dilated pancreatic duct (string of pearls sign with dilated duct)
Look for calculi within duct

Chronic pancreatitis sonographic findings

16

Acute pancreatits
Thrombosis of portal system
Pancreatic pseudocyst
Dilated common bile duct

Chronic pancreatitis differential considerations

17

Asymptomatic unless large enough to put pressure on other organs
Increased amylase and lipase
Increased Alkine Phos if obstruction develops

Pancreatic Pseudocyst clinical findings

18

Well-defined mass, usually in area of pancreas
Increased through transmission
Variable size (round or oval)
May have debris at bottom

Pancreatic Pseudocyst sonographic findings

19

True cyst
fluid filled cystadenoma

Pancreatic pseudocyst differential considerations

20

Asymptomatic, often found in patients with polycystic renal disease

Autosomal dominant polycystic kidney diseases clinical findings

21

Well-defined mass with serous fluid
Size varies from microscopic to several

Autosomal dominant polycystic kidney disease sonographic findings

22

Pseudocyst
Other cystic lesions of the pancreas

Autosomal dominant polycystic kidney disease Differential considerations

23

Asymptomatic
Patients may have CNS and retinal hemangioblastomas, visceral cysts, pheochromocytomas, and renal cell carcinoma

Von hippel lindau disease clinical findings

24

Well defined mass with thick fluid; calcification
Single or multiple
Size varies from microscopic to several centimeters

Von hippel lindau disease sonographic findings

25

Pseudocyst
Other cystic lesions of the pancreas

Von hippel lindau disease differential considerations

26

Asymptomatic

Cystic fibrosis clinical findings

27

Well defined mass with serous fluid
Size varies from microscopic to several centimeters

Cystic fibrosis sonographic findings

28

Pseudocyst
Other cystic lesions of the pancreas

cystic fibrosis differential considerations

29

Asymptomatic, often found in infants

True pancreatic cysts clinical findings

30

Well defined mass with serous fluid
Unilocular or multilocular

True pancreatic cysts sonographic findings