Ultrasound diagnosis of acute pancreatitis

*Only for medical professionals to read the reference Mazhu! Ultrasound imaging of acute pancreatitis! Acute pancreatitis is one of the most common diseases of the digestive tract.
Drinking and cholelithiasis are the most common causes, accounting for about 80% of all acute pancreatitis.

Diagnostic criteria (meet any two of the following conditions): typical symptoms of abdominal pain (pain in the upper abdomen and left upper abdomen, which can radiate to the back, chest or both sides).

Amylase or lipase is three times higher than the upper limit of normal.

Imaging examinations such as B-ultrasound, CT or MRI suggest pancreatitis.

Acute pancreatitis is divided into edema type and necrotizing edema type.
The main pathological manifestations of acute pancreatitis are pancreatic interstitial congestion and edema.
The lesions are mild and more common.

The pathological manifestation of necrotizing acute pancreatitis is a large number of pancreatic acinar, fat, vascular necrosis, accompanied by a large amount of surrounding bloody exudate, high mortality, and less common.

The main pathological change of chronic pancreatitis is fibrosis.

Most patients with acute pancreatitis have a history of cholecystitis and gallstones.

The sonogram shows that the pancreas is diffusely or locally enlarged, it may lose its normal shape and its outline is unclear.

The internal echo is reduced, showing diffusely distributed weak spots, with patchy echoes of uneven strength, irregular shape, and unclear boundaries in the middle.

Severe edema presents a dark sound area, like a sonogram of a cyst.

It is often accompanied by increased gastrointestinal gas in the pancreatic area, especially in the head of the pancreas, making it more difficult to detect.

Edema pancreatitis: the pancreas is slightly larger, the edges are regular, the echo of the head and body of the pancreas is reduced, and the pre-distribution is homogeneous.
Edema pancreatitis: the pancreas is diffusely enlarged, the edges are regular, the internal echo is reduced, and the blood vessels behind the pancreas are compressed.
The ultrasonographic characteristics of chronic pancreatitis are: the pancreas is slightly enlarged or limited, the surface is uneven, and the boundary with the surrounding tissues is not clear.

If there is a limited liquid dark area around, the external pseudocyst cannot be ruled out.

The internal echo is enhanced, coarse, and uneven.

The main pancreatic duct is widened and can be beaded, varying in thickness.

Sometimes a strong echogenic mass of stones is seen in the liquid dark area of ​​the pancreatic duct, with sound shadow behind.

Necrotizing pancreatitis: the pancreas is significantly enlarged, the edges are not smooth, and the internal echo is uneven, and hypoechoes are seen around the pancreas.
Necrotizing pancreatitis: the pancreas is significantly enlarged, the edges are not smooth, and the edges are intermittent.
High-low heterogeneous changes, the blood vessels behind the pancreas show unclear necrotic pancreatitis: pancreatic shape is not regular, pancreatic echo is not homogeneous, narrow band hypoechoic is seen around the pancreas, and irregular anechoic masses are seen in the front of the pancreas (Encapsulated effusion) In addition: the ultrasound performance of acute pancreatitis is significantly lagging behind the clinical symptoms and abnormal serum amylase, so the ultrasound image of some pancreatitis does not even change abnormally, so as ultrasound doctors, we need to be aware of our shortcomings in this area.
, Do not jump to conclusions.