[Sonography of the pancreas]

Sonography was the first non-invasive method that allowed reproducible demonstration of the pancreas. The organ is located in the anterior pararenal space, it is 12-15 cm long. The pancreatic head is in direct contact with the duodenum, the body is located behind the posterial wall of the stomach and the pancreatic tail has topographic relation to the left kidney and to the hilum of the spleen. The main guiding vessel in the transverse scan is the splenic vein. The main value of sonography in acute pancreatitis is description of the course of the inflammatory process and delineation of a biliary etiology. The sensitivity in the demonstration of pseudocysts larger than 2-3 cm is about 90%. In chronic pancreatitis sonography often demonstrates a normal organ. In advanced cases an irregular echopattern with echogenic zones and irregular outer contours are seen. Endoscopic sonography is particularly valuable in demonstrating abnormalities of the pancreatic duct. Dilatation of its tributaries and irregularities of its wall are sharply depicted. 80% of pancreatic carcinomas are echopoor and carcinomas between 2-3 cm in size can be diagnosed by sonography in a few patients. However, the overall prognosis of pancreatic carcinoma has remained unchanged in the last years.