Secondary ultrasound findings in pancreatic adenocarcinoma

Secondary ultrasound findings in pancreatic adenocarcinoma The most obvious secondary feature of ultrasound images carcinoma of the head of pancreas is the dilated biliary system In a recent series of 62 pancreatic cancers, biliary dilatation occurred in 69%, pancreatic duct dilatation in 37% and the double duct sign (pancreatic and biliary duct dilatation) in 34% of patients. Although the gallbladder is frequently dilated with no visible stones, this is not always the case; incidental gallstones may be present, causing chronic inflammation which prevents the gallbladder from dilating. For this reason it is imperative that the common duct is carefully traced down to the head of pancreas to identify the cause of obstruction.
A thorough search for lymphadenopathy and liver metastases should always be made. CT is usually the method of choice for staging purposes. If the mass is large, it is not possible to differentiate whether it arises from the ampulla of Vater or the usually academic at this stage.
Colour Doppler can demonstrate considerable vascularity within the mass and is also important in identifying vascular invasion of the coeliac axis, superior mesenteric artery, hepatic, splenic and/or gastroduodenal arteries and of the portal and splenic veins, a factor which is particularly important in assessing the suitability of the tumour for curative resection. The recognition of involvement of peripancreatic vessels by carcinoma with colour Doppler, together with the ultrasound assessment of compression or encasement of these vessels, has been found to be highly sensitive and specific (79%and 89%) for diagnosing unresectability,19 thus the need for further investigative procedures such as CT may be avoided, particularly in cases of large tumours.

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