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Age: 55

Sex: Male

Indication: Pancreatitis

Sonographic Murphy sign: Negative

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Case #35


Findings

  • Visualized pancreatic parenchyma is heterogeneous and hypoechoic
  • Borderline dilation of the main pancreatic duct, which measures up to 3 mm in diameter
  • Echogenic material within the main portal vein extending from the portosplenic confluence into the right and left portal veins
  • No flow is demonstrated in the left portal vein on Doppler imaging with decreased, bidirectional flow in the main and right portal veins
  • Increased hepatic parenchymal echogenicity
  • Round, hypoechoic lesion in the right hepatic lobe measuring 1.2 x 1.5 x 1.3 cm with posterior acoustic enhancement, compatible with a cyst
  • Normal appearance of the gallbladder with no gallstones identified
  • No intrahepatic or extrahepatic biliary duct dilation
  • Normal appearance of the right kidney


Diagnosis

  • Portal vein thrombosis
  • Pancreatitis

Sample Report

Portal vein thrombosis extending from the portosplenic confluence into the right and left portal veins with occlusion of the left portal vein.

Visualized pancreatic parenchyma is heterogeneous and hypoechoic, consistent with reported pancreatitis.

No ascites or peripancreatic collection identified, though CT could provide further evaluation.

Borderline dilation of the main pancreatic duct measuring up to 3 mm in diameter, which may relate to chronic pancreatitis. Although no obstructing lesion is visualized, CT could provide further evaluation.

Normal appearance of the gallbladder with no gallstones identified.

Increased hepatic parenchymal echogenicity, suggestive of steatosis.


Discussion

  • Make sure to evaluate the gallbladder and biliary tree in cases of pancreatitis since gallstones are a leading cause of pancreatitis
  • Also make sure to assess for complications including venous thrombosis, peripancreatic collections, and tissue necrosis
  • In general, CT is the preferred imaging modality in the assessment of patients with pancreatitis



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