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CHRONIC PANCREATITIS

Chronic pancreatitis is defined as a prolonged inflammatory disease of the gland associated with progressive parenchymal destruction and loss of endocrine and exocrine functions.

Ultrasound Findings

Image findings are generally poor predictors of the clinical severity of chronic pancreatitis.

Multiple Calcifications:
The calcifications are caused by stones within the main or branch pancreatic ducts. Detecting multiple pancreatic calcifications allows a confident diagnosis of chronic pancreatitis. Sonography is less sensitive than CT in detecting pancreatic calcifications. On occasion, a diffusely hyperechoic pancreas may be an indicator of chronic pancreatitis.


Picture1. Multiple pancreatic calcifications (see arrow).

Ductal Dilatation:
Chronic pancreatitis may cause dilatation of the pancreatic or common bile duct. Some researchers feel that dilatation of the main pancreatic duct is the most reliable sign of chronic pancreatitis.

Focal Mass:
A focal mass is seen in about one third of patients with chronic pancreatitis. This results from proliferation of fibrous tissue and infiltration by inflammatory cells. Sonographically, the mass is usually small, measuring about 2 to 3 cm in diameter. It is usually hypoechoic, with a disorganized echo pattern. However, there is a wide range in size and texture. Some masses may be quite large and strongly echogenic. Focal masses with chronic pancreatitis must be differentiated from neoplasm. A few features favor the diagnosis of a benign inflammatory mass over a tumor:

1-Calcification within the mass makes the diagnosis of chronic pancreatitis almost certain. Hyperechoic masses, even those without discrete calcifications, are usually caused by chronic pancreatitis, even though hyperechoic carcinoma is not rare.

2- The presence of duct dilatation within the mass generally means that the mass is caused by chronic pancreatitis, although carcinoma may occasionally have internal hypoechoic regions as well.

Pseudocysts:
Chronic asymptomatic pseudocysts may be found in patients with chronic pancreatitis. Pseudocysts also occur in association with pancreatic carcinoma.

Summary

The role of ultrasound:
1- to document the morphological abnormalities of the gland. These include focal mass, ductal dilatation, and stones
2- to monitor the development and evolution of pseudocysts
3- to look for associated abnormalities that may occur elsewhere in the abdomen.

REFERENCES:
[1]Abdominal Ultrasound. E.E.Sauerbrei, K.T.Nguyen, R.L.Nolan. 1992.
2]Sonography of the Abdomen. R.B.Jeffrey, P.W.Rolls. 1995


 

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