spleen and pancrease
DESCRIPTION
超音波醫學會的spleen and pancrease不少是網路上的東西TRANSCRIPT
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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
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Pancrease
• Normal picture
➡ vascular marker
• Pathological pancrease
➡inflammation- acute/chronic pancretitis
➡tumor
2011年8月6日星期六
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When
2011年8月6日星期六
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When
• Jaundice
• abdominal pain
• Not suitable for CT
- Pregnant, contrast allergies.....
2011年8月6日星期六
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2011年8月6日星期六
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Anatomy
• Retroperitoneal
• Post to stomach
• Water
• Duodenal C-loop
• Vascular
2011年8月6日星期六
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Anatomy
• Retroperitoneal
• Post to stomach
• Water
• Duodenal C-loop
• Vascular
2011年8月6日星期六
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Transverse view
2011年8月6日星期六
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Vessel of pancreas
• Splenic vein
• Post to body and tail
• Cobra head
• Pancreatic mass located anterior to splenic vein
2011年8月6日星期六
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2011年8月6日星期六
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SMV
• Parallel and right of SMA
• Landmark of pancrease
- Head is lateral
- Neck is anterior
- Uncinate is postierior
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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2011年8月6日星期六
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Main portal vein and IVC
• Pancreatic head inferiorly
• Marker for the head
• 4cm in length
2011年8月6日星期六
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SMA
• Anterior to aorta
• Echogenic mesenteric fat
• Marker for the body
• Shallow angle
2011年8月6日星期六
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SMA
• Anterior to aorta
• Echogenic mesenteric fat
• Marker for the body
• Shallow angle
2011年8月6日星期六
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SMA
• Anterior to aorta
• Echogenic mesenteric fat
• Marker for the body
• Shallow angle
2011年8月6日星期六
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2011年8月6日星期六
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Splenic artery
• Along with cranial border of body and tail
• Tortuous course
2011年8月6日星期六
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Pitfall
2011年8月6日星期六
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Pitfall
2011年8月6日星期六
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Pitfall
2011年8月6日星期六
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Pitfall
2011年8月6日星期六
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Normal size
• Head: <4cm
• Body: <2cm
• Tail: <2.5cm
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Sagittal view
2011年8月6日星期六
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Vascular marker
2011年8月6日星期六
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Vascular marker
2011年8月6日星期六
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Vascular marker
2011年8月6日星期六
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Pancreatic duct
• Size<2mm
• Center of gland
2011年8月6日星期六
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Pancreatic duct
• Size<2mm
• Center of gland
2011年8月6日星期六
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Uncinate process
• Dorsal and ventral anlage that fuse
• Different fat content and echogenicity
2011年8月6日星期六
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Pathologic
• Inflammation
- Acute
- Chronic
- Complication
• Pancreatic tumor
2011年8月6日星期六
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Acute pancreatitis
2011年8月6日星期六
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Acute pancreatitis
• Biliary pancreatitis
• Complication
• Fluid collection
• Unsuspected cases
2011年8月6日星期六
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Acute pancreatitis
• 20% is normal
• Diffuse and focal
• Hypoechoic
2011年8月6日星期六
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Acute pancreatitis:focal
• Mimic carcinoma
• Usually in head
2011年8月6日星期六
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Acute pancreatitis:focal
• Mimic carcinoma
• Usually in head
2011年8月6日星期六
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Complication
• Pancreatic infection and abscess
• Pseudocyst formation
• Pseudoaneurysm, thrombosis
2011年8月6日星期六
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Acute pancreatitis
2011年8月6日星期六
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Acute pancreatitis
2011年8月6日星期六
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Acute pancreatitis
2011年8月6日星期六
![Page 47: Spleen and Pancrease](https://reader033.vdocuments.mx/reader033/viewer/2022051412/54fb45794a7959575b8b5070/html5/thumbnails/47.jpg)
Acute pancreatitis
2011年8月6日星期六
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2011年8月6日星期六
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2011年8月6日星期六
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Complication
2011年8月6日星期六
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Pseudocyst
• 90% of cystic mass
• Encapsulated, fluid collection
• Multiple
• Calcified
• Complication
2011年8月6日星期六
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Pseudocyst
• 90% of cystic mass
• Encapsulated, fluid collection
• Multiple
• Calcified
• Complication
2011年8月6日星期六
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Pseudocyst
• 90% of cystic mass
• Encapsulated, fluid collection
• Multiple
• Calcified
• Complication
2011年8月6日星期六
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2011年8月6日星期六
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Complication of pseudocyst
Infection
Rupture
Hemorrhage
2011年8月6日星期六
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Chronic pancreatitis
• Calcification
• Heterogeneous
• Irregular dilated duct and outline
• Decrease size
• Pseudotumor penetrating duct sign
2011年8月6日星期六
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2011年8月6日星期六
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2011年8月6日星期六
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Pancreatic tumor
• Pancreatic carcinoma
• Islet cell tumor
• Cystic tumor
2011年8月6日星期六
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Pancreatic cancer
• Head(60%), body and tail(40%)
• Solid, focal, irregular, hypoechoic mass
• Vessel invasion, encasement
• P duct, bile duct dilation
2011年8月6日星期六
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2011年8月6日星期六
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Pancreatic carcinoma
2011年8月6日星期六
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Pancreatic tail carcinoma
2011年8月6日星期六
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1. Microcystic adenoma(serous)
2. Macrocystic adenomas(Mucinous)
3. Intraductal paipillary mucinous neoplasm
* Mucinous tumors have malignant potential
Cystic tumor
2011年8月6日星期六
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Microcystic adenoma
• Smooth margin
• Heterogenic
2011年8月6日星期六
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Macrocystic adenoma
2011年8月6日星期六
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Cystic tumor
2011年8月6日星期六
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IPMN
2011年8月6日星期六
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Islet cell tumor
• Insulinoma, gastrinoma, VIP-oma...
• Small homogenous hypoechoic tumor
• EUS Sensitive and FNA biopsy
2011年8月6日星期六
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Pancreatic trauma
2011年8月6日星期六
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Pancreatic trauma
2011年8月6日星期六
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Pancreatic trauma
2011年8月6日星期六
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Spleen
2011年8月6日星期六
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Spleen
• Normal picture
• Post. axillary line
• Accessory spleen
• Splenomegaly
• Splenic cystic lesion
• Splenic solid lesion
2011年8月6日星期六
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Longitudinal
Splenic hilum
2011年8月6日星期六
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Longitudinal
Splenic hilum
2011年8月6日星期六
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Longitudinal
Lt Kidney
Adrenal
Spleen
2011年8月6日星期六
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Longitudinal
Lt Kidney
Adrenal
Spleen
2011年8月6日星期六
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Longitudinal
Lt Kidney
Adrenal
Spleen
2011年8月6日星期六
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Longitudinal
Lt Kidney
Adrenal
Spleen
2011年8月6日星期六
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Normal spleen
• Homogeneous
• Moderate echogenic
• Wandering spleen
2011年8月6日星期六
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Splenomegaly
• Lymphoproliferative disease (lymphoma)
• Portal hypertension
• Infectious (mononucleosis, AIDS)
• Infiltrative (Gaucher’s)
2011年8月6日星期六
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Size
• A>10cm & B>5cm
• A*B >30
• A*B>20A
B
2011年8月6日星期六
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Size
• A>10cm & B>5cm
• A*B >30
• A*B>20A
B
2011年8月6日星期六
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Size
• A>10cm & B>5cm
• A*B >30
• A*B>20A
B
2011年8月6日星期六
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Accessory spleen
• Isoechoic, round, small mass
• Splenic hilum
• 10% patient
• Solitary or multiple
2011年8月6日星期六
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2011年8月6日星期六
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Cystic mass
• Cyst
• Hematoma
• Abscess
• Pseudoaneurysm
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Cyst
• Primary: rare
• Secondary old trauma pseudocyst
• Hemorrhage, infection
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Trauma
• Irregular hyperechoic or hypoechoic
• Subcapsular hematoma dopplar can help
• Perisplenic fluid
• Contrast ultrasound
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Splenic laceration
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Subcapsular hematoma
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Subcapsular hematoma
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Contrast ultrasound
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Infection
• Usually secondary causeIE, septicemia......
• Bacterial: hypoehcoic or complex with irregular margin
• Fungal: target sign, small(1cm)
• Granulomatous: calcification
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Microabscesses
• Target lesion, bull’s eye lesion
• Fungal: candidiasis
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Candidiasis
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Bacterial abscess
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Psuedoaneurysm
• Trauma or pancretitis
• Dopplar
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Solid masses
• Infarct
• Hemangioma
• Lymphoma
• Metastasis
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Gamm-Gandy bodies
• Hyperechoic without PAS
• Siderotic nodule
• Splenomegaly
• Portal hypertension
• Sickle cell anemia
• PCP infection
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Infarct
• Most common focal lesion
• Peripheral, wedge shape hypoechoic lesion
• Septic emboli
• Thrombosis of splenic vessel
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Calcification
• Hyperechoic with PAS
• TB or histoplasmosis
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Hemangioma
• Rare
• Hyperechoic mass
• Spleen size usually normal
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Lymphoma
• Splenomegaly
• diffuse or focal
• Hypoechoic
• LAP
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Metastasis
• Lung, breast, melanoma
• May be target lesion
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Cystic metastasis
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Thank you
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splenic granuloma
• Hyperechoic lesion
• Tiny shadow
• TB?
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