To assess

To evaluate the structure of the pancreas. Apart from that, it is to perform an initial overall scan without imaging to get an idea what pathology there might be and how it might relate to the patients current complaint.

 

Limitation

• Often you will have problems with bowel gas overlying the pancreas.

  • Ways to overcome this include :

    1. Deep inspiration / expiration

    2. Distend the abdomen against the probe. (ask the patient to push their stomach out as if they are pregnant!)

    3. Give the patient an oral waterload (2-3 glasses).The water is used as a window to look through when it is in the stomach and duodenum.

    4. Scan with the patient erect.

    5. Roll the patient into a rt lateral decubitus position and scan coronally using the spleen as a window to view the splenic tail.

 

Patient Preparation

• Patient should be NPO for 4-6 hours before the study.

 

Equipment Setup

• Highest frequency curved linear array probe as possible.

• Start with 6MHz and work down to 2 or 3 for larger patients.

• Assess the depth of penetration required and adapt.The gallbladder should be able to be scanned using a 7MHZ as it is so superficial.Paediatric and thin pts should be scanned with a 7MHz also.

 

Common Pathology

• Adenocarcinoma

• Pseudocyst

• Pancreatitis

• Fatty change

• Insulinomas

• Pancreatic artery aneurysm/calcification

• Cystic fibrosis

• Congenital / acquired cysts

 

Scanning Technique​

• Begin with the patient supine.

• Begin transversely, high in the epigastrum.

• You may need to apply enough pressure to help displace bowel gas.

• Adjust image depth so the aorta is at the bottom of the screen.

  • Head of pancreas – Use both transverse & sagittal planes as the head can be quite long and continue left caudally for several centimeters.

  • Body of Pancreas – Transverse probe. Use the splenic vein to help identify the pancreas superficial to this.

  • Tail of pancreas – Start with the probe transverse then angle the heel of the probe cephalad and left as the tail can be sitting up under the spleen. Thus the spleen can be used as a window and a left intercostal coronal approach can also be utilised.