Diagnostic Ultrasound - Abdomen and Pelvis

Pancreatic Ductal Carcinoma
Diagnoses: Pancreas
TERMINOLOGY
• Solid epithelial neoplasm from ductal epithelium of
exocrine pancreas
IMAGING
• Ill-defined pancreatic mass obstructing pancreatic and
possibly common bile duct (producing "double duct" sign)
• Best imaging tool: CECT for demonstrating mass and
evaluating resectability
• Without metastatic disease, resectability determined by
vascular involvement
○ Best assessed on CTA using NCCN criteria
• US often first-line imaging to evaluate obstructive jaundice
○ Often shows level of obstruction
○ Not as sensitive as CT or MR for demonstrating mass or
assessing resectability
TOP DIFFERENTIAL DIAGNOSES
• Chronic pancreatitis
KEY FACTS
• Mucinous cystic pancreatic neoplasm
• Lymphoma
• Neuroendocrine tumor of pancreas
• Metastases
CLINICAL ISSUES
• Poor overall prognosis;5-year survival rate of ~ 5%
• Usually presents late with unresectable disease
• Better long-term survival through complete resection
DIAGNOSTIC CHECKLIST
• Heterogeneous pancreatic head mass with ductal
dilatation, upstream atrophy, and often extensive local
extension around vessels, &/or regional metastases
(Left) Graphic shows an
infiltrative mass in the
pancreatic head partially
obstructing the common bile
duct and pancreatic duct.
Superior mesenteric vessels
are encased . Celiac nodes
are present. (Right)
Longitudinal oblique color
Doppler ultrasound shows an
ill-defined, solid, hypoechoic
mass in the pancreatic
head obstructing the terminal
portion of the common bile
duct with proximal dilatation
ſt.
(Left) Longitudinal oblique
color Doppler ultrasound
shows dilatation of the
common bile duct in the porta
hepatis ſt and a solid,
hypoechoic hepatic metastasis
. Note the sludge-filled
gallbladder . (Right)
Transverse transabdominal
ultrasound in the same patient
shows a large, ill-defined,
solid, hypoechoic mass in
the pancreatic head, with
pancreatic duct dilatation ſt
in the atrophic pancreatic
body and tail.
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