EJCAP Online 22(4), December 2012, English

6 Looking at the pancreas

6 Looking at the pancreas

Ultrasound examination of the pancreas

In this video, Pete Mantis explains how to examine the pancreas by ultrasound.

INTRODUCTION

Pancreatic abnormalities are common in clinical veterinary practice and they do not cause any pathognomonic signs. Vomiting and abdominal pain are not specific clinical signs and the biochemical and radiographic findings are often equivocal [1-3]. In clinical practice, radiography is commonly the first imaging modality to be employed in cases of pancreatitis. That is because it is widely available and pancreatic abnormalities do not cause pathognomonic signs. This is commonly followed by ultrasonography that is more helpful than radiography though not very sensitive or specific. Computed tomography (CT) is considered the imaging modality of choice for the pancreas in human medicine and is starting to acquire the same status in veterinary medicine. The reduced availability of CT in veterinary medicine and the increased cost of the examination along with the need for sedation or anaesthesia has limited the use of CT in cases with suspected pancreatic disease in favour of the cheaper, possibly faster ultrasound that does not require sedation or anaesthesia. Although articles start appearing regarding the use of magnetic resonance imaging (MRI) in cases of suspected pancreatic disease it is still early days for MRI of the pancreas in veterinary medicine due to very limited availability and very high cost. Scintigraphy is rarely employed in cases of suspected pancreatic disease in veterinary medicine and it is usually limited to academic institutions and research centres.

Panagiotis (Pete) Mantis

Royal Veterinary College,

University of London,

Hawkshead Lane,North Mymms, Hatfield, Hertfordshire,

GB-AL9 7TA

United Kingdom

E-mail: pmantis@rvc.ac.uk

Panagiotis (Pete) Mantis graduated from the Faculty of Veterinary Medicine of the Aristotle University of Thessaloniki, Greece. He completed a veterinary diagnostic imaging residency at the Royal Veterinary College (UK), following which he worked in first opinion practices and referral hospitals in London. In 2000, he joined the Department of Veterinary Clinical Sciences at the Royal Veterinary College and is currently Senior Lecturer in Radiology. Pete is a European and RCVS Specialist in Veterinary Diagnostic Imaging and a Fellow of the Higher Education Academy. He is Senior Lecturer in radiology at the Royal Veterinary College, University of London. Pete is a regular author, speaker and CPD tutor on the subjects of small animal radiology, ultrasonography, computed tomography and magnetic resonance imaging. Pete’s current research focus is on ultrasound biomicroscopy of the canine skin.

CT images of an 8-year-old Rottweiler with pancreatitis transverse image. Note the thick pancreas surrounded by an ill-defined mesentery. Slide with your mouse over the image to locate the pancreas and identify the structures

right kidney

abdominal wall muscle

abdominal fat

ascending Duodenum

descending duodenum

pancreas

spleen

stomach

aorta

prostate

bladder

small intestine

left kidney

lungs

liver

ill-defined mesentery

colon

pancreas

spleen

stomach

heart

Oblique sonogram of the whole pancreas (arrows) in a cat. The left limb is visible to the right of the image and the pancreatic duct appears as an anechoic channel within the left limb.

The stomach, spleen, transverse colon, splenic vein and portal vein can all potentially be used for the identification of the left limb of the pancreas.

Logitundinal sonogram of the body of the

pancreas which is visible between the stomach (st) and portal vein (pv).

The pyloric antrum, right pancreatic lobe and portal vein can be used for the identification of the body of the pancreas.

Longitudinal sonogram of the right pancreatic lobe. Observe the pancreaticoduodenal vein which appears as an anechoic channel within the right limb of the pancreas.

The right kidney, descending duodenum and pancreaticoduodenal vein can be used as landmarks for the right pancreatic lobe

Slide with your mouse over the image to see how to use these landmarks.

Pancreatic insulinoma appears as a single hypoechoic nodule (arrows) in the right pancreatic lobe.

What do you see?

Click here for details

(a) Sagittal sonogram of the pancreas in a West Highland White terrier with pancreatitis. The pancreas appears thick and hypoechoic surrounded by hyperechoic mesenteric fat. (b) Sagittal sonogram of the left lobe and body of the pancreas of the Scottish terrier in figure 1. The body is hypoechoic and thick while the left lobe appears irregular, thick and with mixed echogenicity. The visible pancreas is surrounded by hyperechoic mesenteric fat.

Pancreatic oedema of the right pancreatic lobe (A) and the left pancreatic lobe (B) in two different dogs. The pancreas is enlarged and contains anechoic stripes. Ascites is also visible, more marked in image (B).

Oblique sonogram of a single large pancreatic cyst (?) at the beginning of the right limb of the pancreas. Part of the stomach (st) is also visible.

(A) Sagittal sonogram of the pancreas in a West Highland White Terrier with pancreatitis. The pancreas appears thick and hypoechoic surrounded by hyperechoic mesenteric fat. (B) Sagittal sonogram of the left lobe and body of the pancreas of the Scottish Terrier in figure 1. The body is hypoechoic and thick while the left lobe appears irregular, thick and with mixed echogenicity. The visible pancreas is surrounded by hyperechoic mesenteric fat.

Ultrasound examination of the pancreas

In this video, Pete Mantis explains how to examine the pancreas by ultrasound.

Look at the slides, describe the image, then click for details.

What do you see?

Fifty shades of grey

click here to locate the pancreas and identify the other structures

Click to read more about this author

by Panagiotis (Pete) Mantis

Schematic of the location of the pancreas (green) in relation to the other abdominal organs, which serve as landmarks when performing ultrasound. Click with your mouse on the image to see how to use these landmarks.

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Volume 22(4), December 2012 SPECIAL ISSUE

Looking at the pancreas

Commissioned paper

Diagnostic imaging of the pancreas in dogs and cats

Read more...

Pancreatic abnormalities are common in clinical veterinary practice and they do not cause any pathognomonic signs. Vomiting and abdominal pain are not specific clinical signs and the biochemical and radiographic findings are often equivocal. In clinical practice, radiography is commonly the first imaging modality to be employed ...