Ultrasound appearances pancreas

The texture of the pancreas is rather coarser than that of the liver. The echogenicity of the normal pancreas alters according to age. In a child or young person it may be quite bulky and relatively hypoechoic when compared to the liver. In adulthood, the pancreas is hyperechoic compared to normal liver, becoming increasingly so in the elderly, and tending to atrophy (Fig. below). The pancreas does not have a capsule and its margins can appear rather ill-defined, becoming infiltrated with fat in later life.
These age-related changes are highly significant to the sonographer; what may be considered normal in an elderly person would be abnormally hyperechoic in a younger one, and may represent a chronic  inflammatory state. Conversely a hypoechoic pancreas in an older patient may represent acute inflammation, whereas the appearances would be normal in a young person.
The main pancreatic duct can usually be visualized in the body of pancreas, where its walls are perpendicular to the beam. The normal diameter is 2 mm or less.
The common bile duct can be seen in the lateral portion of the head and the gastroduodenal artery lies anterolaterally. The size of the uncinate process varies.
Ultrasound images Pancreas in a young person, demonstrating normal hypoechogenicity
The normal adult pancreas is
slightly more echogenic than the liver.
Ultrasound images The pancreas becomes hyperechoic in an older patient
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