Anyone who stops learning is old, whether at twenty or eighty. ~Henry Ford-
Each day learn something new, and just as important, relearn something old. ~Robert Brault-
You don't understand anything until you learn it more than one way. ~Marvin Minsky-
In the 7th segment of the liver, a 13 mm rounded echogenic area is seen, elsewhere the liver is homogeneous. - Dont`t confuse with focal fatty infiltration of the liver usually seen arround the GB, or the echogenic ligamentum teres.
- A hemangioma can be echogenic or isoechoic.
- Smooth margins, round or oval in shape.
- Often multiple, may contain calcifications, rarely has a peripheral rim.
- Unlike FNH hemangiomas are vascularised in a peripheral-to-central pattern => aka iris diaphragm sign.
Arterial phase (20-30 sec): outer portions enhance, center remains hypoechoic.
Portal phase (40-100 sec): central portions become increasingly echogenic.
Venous phase (110-180 sec): the entire leasion is hypoechoic.
The ultrasonographic anatomy of the pancreas, look for the splenic vein to find the pancreas.
The splenic vein joins the superior mesenteric vein to form the portal vein.
The pancreas normally has an echogenic fatty ultrasonographic texture.
Vascular anatomy arround the pancreas:
Parts and anatomic relations
lies within the curve of the duodenum
uncinate process is a prolongation of the head. The superior mesenteric artery and vein crosses this process.
the part of the head that wraps behind the superior mesenteric artery and vein and comes to lie adjacent to the ascending part of the duodenum.
a constricted portion to the left of the head. It abuts the pylorus above and the beginning of the portal vein behind.
anterior surface separated from the stomach by the omental bursa
posteriorly related to the aorta, splenic vein, left kidney and renal vessels, left suprarenal, origin of superior mesenteric artery and crura of diaphragm.
extends into the lienorenal ligament and abuts the spleen
Pancreatic duct (Wirsung)
Whats the clinical significance?
Compression, obstruction or inflammation of the pancreatic duct may lead to acute pancreatitis. The most common cause for obstruction is choledocholithiasis, or gallstones in the common bile duct. Obstruction can also be due to Duodenal Inflammation in Crohn's Disease. A gallstone may get lodged in the constricted distal end of the ampulla of Vater, where it blocks the flow of both bile and pancreatic juice into the duodenum. Bile backing up into the pancreatic duct may initiate pancreatitis.
The mean diameter of the duct in the area of the head-neck 3 mm, in the body proximal and distal to the neck, duct diameters were 2.1 and 1.6 mm, respectively.
The consensus is that most people have a common bile duct diameter of around 5mm, +/- 1 mm. However, there are reports were people with no hepatobilliary disease have a "normal" common bile duct size up to 10 mm. Also, there is a correlation between common bile duct diameter and age. Most physicians would like to check things further if the common bile duct diameter is greater than about 7 mm, particularly if there are symptoms indicating hepatobilliary disease (abdominal pain with or without jaundice, fever etc.). Finally, even "normal" common bile duct sizes do not exclude the possibility of disease (such as stones).
CBD is considered dilated in adults if its diameter> 7mm.