Diagnostic Ultrasound - Abdomen and Pelvis

Solid Pancreatic Lesion
○ Usually seen in older women (6th decade)
• Mucinous Cystic Neoplasm of Pancreas
○ More common in pancreatic body and tail
○ Well-demarcated, anechoic or hypoechoic, thick-walled,
cystic mass
– Uni-/multilocular cysts separated by thick echogenic
septations
○ Solid papillary tissue protruding into tumor suggests
malignancy
○ Liver metastases appear as thick-walled cystic hepatic
lesions
○ Seen almost exclusively in middle-aged women
Helpful Clues for Less Common Diagnoses
• Metastasis
○ Nonspecific imaging findings
○ Focal or diffuse involvement
○ Renal cell carcinoma: Most common primary; often
solitary
○ Other sources: Lung, GI, breast, melanoma, ovary, liver;
typically disseminated disease
• Lymphoma
○ Secondary lymphoma more common than primary
lymphoma
– Known clinical history of systemic lymphomatous
involvement
○ Large, homogeneous, solid mass
○ Presence of peripancreatic nodal masses
○ Peripancreatic vessels displaced or stretched
• Solid Pseudopapillary Neoplasm
○ Most common in pancreatic tail
○ Well-demarcated, large, heterogeneous echogenic solid
and cystic mass
○ Small cystic areas often present due to tumor
degeneration
– Often with intratumoral hemorrhage
○ Dystrophic calcification occasionally seen
○ No pancreatic duct dilatation or calcification
○ Prominent vascular soft tissue components
– → hypervascular pattern with color Doppler
○ Liver metastases seen in ~ 4% of patients
○ Typically seen in young women (< 35 years)
• Intrapancreatic Splenule
○ Congenital anomaly arising from aberrant splenic
embryologic fusion
○ Second most common location for accessory spleens is in
the pancreatic tail
○ Appears as small, well-circumscribed solid mass, usually
at tip and not > 3 cm from tail
○ Can easily be mistaken for primary pancreatic mass,
particularly neuroendocrine tumor
○ Follows attentuation of spleen on all phases of CT
imaging and intensity of spleen on all MR sequences
○ Confirm with Tc-99m labeled heat damaged red blood
cells
SELECTED REFERENCES
1. Al-Hawary MM et al: Mimics of pancreatic ductal adenocarcinoma. Cancer
Imaging. 13(3):342-9, 2013
2. Bhosale PR et al: Vascular pancreatic lesions: spectrum of imaging findings
of malignant masses and mimics with pathologic correlation. Abdom
Imaging. 38(4):802-17, 2013
3. Dimcevski G et al: Ultrasonography in diagnosing chronic pancreatitis: new
aspects. World J Gastroenterol. 19(42):7247-57, 2013
4. Coakley FV et al: Pancreatic imaging mimics: part 1, imaging mimics of
pancreatic adenocarcinoma. AJR Am J Roentgenol. 199(2):301-8, 2012
5. Raman SP et al: Pancreatic imaging mimics: part 2, pancreatic
neuroendocrine tumors and their mimics. AJR Am J Roentgenol. 199(2):309-
18, 2012
Differential Diagnoses: Pancreas
Pancreatic Ductal Carcinoma
Pancreatic Ductal Carcinoma
(Left) Transverse
transabdominal ultrasound
shows a large infiltrative,
solid, hypoechoic mass in the
head of the pancreas
abutting the superior
mesenteric vein ſt, raising
concern for vascular
encasement. (Right)
Transverse transabdominal
ultrasound shows a poorly
defined infiltrative hypoechoic
mass in the head of the
pancreas, obstructing the
pancreatic duct, which is
dilated upstream ſt.
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