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

• Jaundice

• abdominal pain

• Not suitable for CT

- Pregnant, contrast allergies.....

Anatomy

• Retroperitoneal

• Post to stomach

• Water

• Duodenal C-loop

• Vascular

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

• 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

• 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

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

• Biliary pancreatitis

• Complication

• Fluid collection

• Unsuspected cases

Acute pancreatitis

• 20% is normal

• Diffuse and focal

• Hypoechoic

Acute pancreatitis:focal

• Mimic carcinoma

• Usually in head

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

Pseudocyst

• Multiple

• Calcified

• Complication

Pseudocyst

• 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

Islet cell tumor

• Insulinoma, gastrinoma, VIP-oma...

• Small homogenous hypoechoic tumor

• EUS Sensitive and FNA biopsy

Pancreatic trauma

Spleen

• Normal picture

• Post. axillary line

• Accessory spleen

• Splenomegaly

• Splenic cystic lesion

• Splenic solid lesion

Longitudinal

Splenic hilum

Longitudinal

Splenic hilum

Longitudinal

Lt Kidney

Adrenal

Spleen

Longitudinal

Lt Kidney

Adrenal

Spleen

Longitudinal

Lt Kidney

Adrenal

Spleen

Longitudinal

Lt Kidney

Adrenal

Spleen

Normal spleen

• Homogeneous

• Moderate echogenic

• Wandering spleen

Splenomegaly

• Lymphoproliferative disease (lymphoma)

• Portal hypertension

• Infectious (mononucleosis, AIDS)

• Infiltrative (Gaucher’s)

• A>10cm & B>5cm

• A*B >30

• A*B>20A

• A>10cm & B>5cm

• A*B >30

• A*B>20A

• A>10cm & B>5cm

• A*B >30

• A*B>20A

Accessory spleen

• Isoechoic, round, small mass

• Splenic hilum

• 10% patient

• Solitary or multiple

Cystic mass

• Cyst

• Hematoma

• Abscess

• Pseudoaneurysm

• 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

Documents

The Spleen

SCINTIGRAPHY OF THE LIVER AND SPLEEN HEPATOBILIARY SCINTIGRAPHYradiology.med.miami.edu/documents/2009GITrLiver_Spl.… · · 2011-07-19scintigraphy of the liver and spleen hepatobiliary

Pancreas & spleen

Spleen Lac

Thymus and Spleen

Lymph Nodes & Spleen - gmch.gov.in lectures/Pathology/spleen thymus.pdf · spleen tonsils inc ... CVC of spleen in CHF, acute malaria typhoid fever bacterial endocarditis, SLE, rheumatoid

The cranial abdomen: Liver and Spleen

Spleen and thymus

Gallbladder, Liver, Pancreas and Spleen

Ultrasound of pancrease in Radiology

The spleen and sickle cell disease: the sick(led) · PDF fileThe spleen and sickle cell disease: the sick(led) spleen Valentine Brousse,1,2,3 Pierre Buffet3,4,5 and David Rees6 1Department

Squee and Spleen the Goblin Techies

Liver and Spleen

Spleen Trauma

Liver,bile duct,pancreas and spleen

Baudelaire. Spleen

Pancreas and Spleen

Functions of spleen and lymph nodes

Cvc of liver and spleen

Liver & Spleen