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Age: 48

Sex: Male

Indication: Right upper quadrant pain

Sonographic Murphy sign: Negative

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Case #7


Findings

  • Enlarged, hypoechoic appearance of the pancreas with surrounding small volume fluid
  • Liver is enlarged, measuring 18.5 cm in craniocaudal span
  • Normal appearance of the gallbladder and biliary tree
  • Normal appearance of the right kidney


Diagnosis

Acute pancreatitis

Sample Report

Edematous appearance of the pancreas with surrounding small volume fluid, consistent with acute pancreatitis. Contrast-enhanced CT could further evaluate for complications of pancreatitis.

No cholelithiasis or evidence of acute cholecystitis.

Hepatomegaly.


Discussion

  • The pancreas is sometimes difficult to view in its entirety by ultrasound due to overlying bowel gas
  • In the setting of pancreatitis, associated duodenal ileus may further obscure the pancreas
  • Ultrasound findings supportive of acute pancreatitis include:
    • Increased thickness of the pancreatic parenchyma – the pancreatic head and body should normally measure less than 3 cm in thickness
    • Decreased parenchymal echogenicity – as a reference, the pancreatic parenchyma is normally slightly more echogenic than the liver and similar in echogenicity to the spleen and renal cortex
    • Peripancreatic fluid
  • Make sure to also closely evaluate the gallbladder and biliary tree in these patients since biliary calculi are a common cause for pancreatitis



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