Pancreatic ultrasound

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Pancreatic ultrasound can be used to assess for pancreatic malignancy, pancreatitis and its complications, as well as for other pancreatic pathology.

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"
  • pancreatic head
    • in addition to the above, a right subcostal approach with the transducer angled medially may be useful
  • pancreatic tail
    • can be difficult to visualize
    • a water filled stomach may be used as a window
    • 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