Pancreatitis and Pseudocysts

  • Steffen Rickes
  • Holger Neye


Ultrasonography (US) is a noninvasive imaging modality which is often the first imaging technique in the evaluation of patients with pancreatic diseases. It has undergone significant advances in recent years. In this chapter the value of US in the diagnosis of pancreatitis and pseudocysts will be described and discussed. The article is focused on B-mode US, Doppler sonography and contrast-enhanced ultrasound (CEUS).


Acute Pancreatitis Chronic Pancreatitis Main Pancreatic Duct Pancreatic Necrosis Autoimmune Pancreatitis 
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  1. 1.
    Rickes S, Uhle C (2009) Advances in the diagnosis of acute pancreatitis. Postgrad Med J 85:208–212PubMedCrossRefGoogle Scholar
  2. 2.
    Balthazar EJ (1989) CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 27:19–37PubMedGoogle Scholar
  3. 3.
    Uhl W, Warshaw A, Imrie C et al (2002) IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573PubMedCrossRefGoogle Scholar
  4. 4.
    Balthazar EJ, Freeny PC, van Sonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193:297–306.PubMedGoogle Scholar
  5. 5.
    Rickes S, Treiber G, M.nkemüller K, et al (2006) Impact of operators experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: A prospective comparison using endoscopic retrograde cholangiography as gold standard. Scand J Gastroenterol 41:838–843PubMedCrossRefGoogle Scholar
  6. 6.
    de Lédinghen V, Lecesne R, Raymond JM et al (1999) Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 49:26–31PubMedCrossRefGoogle Scholar
  7. 7.
    Soto JA, Barish MA, Alvarez O, Medina S (2000) Detection of choledocholithiasis with MR cholangiography: Comparison of three dimensional fast spin-echo and single-and multisection half-Fourier rapid acquisition with relaxation enhancement sequences. Radiology 215:737–745PubMedGoogle Scholar
  8. 8.
    Moo JH, Cho YD, Cha SW et al (2005) The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol 100:1051–1057CrossRefGoogle Scholar
  9. 9.
    Rickes S, Uhle C, Kahl S et al (2006) Echo-enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis. Gut 55:74–78PubMedCrossRefGoogle Scholar
  10. 10.
    Rickes S, M.nkemüller K, Malfertheiner P (2007) Acute severe pancreatitis: contrast-enhanced sonography. Abdom Imaging 32:362–364PubMedCrossRefGoogle Scholar
  11. 11.
    Rickes S, Rauh P, Uhle C et al (2007) Contrast-enhanced sonography in pancreatic diseases. Eur J Radiol 64:183–188PubMedCrossRefGoogle Scholar
  12. 12.
    D’Onofrio M, Zamboni G, Faccioli N et al (2007) Ultrasonography of the pancreas. 4. Contrast-inhanced imaging. Abdom Imaging 32:171–181PubMedCrossRefGoogle Scholar
  13. 13.
    Ripollés T, Martínez MJ, López E et al (2010) Contrast-enhanced ultrasound in the staging of acute pancreatitis. Eur Radiol 20:2518–2523PubMedCrossRefGoogle Scholar
  14. 14.
    Procacci C (2002) Non-traumatic abdominal emergencies: imaging and intervention in acute pancreatic conditions. Eur Radiol 12:2407–2434PubMedGoogle Scholar
  15. 15.
    Balthazar EJ (ed) (2009) Imaging of the pancreas. Acute and chronic pancreatitis. Springer, BerlinGoogle Scholar
  16. 16.
    Laws HL, Kent RB III (2000) Acute pancreatitis: management of complicating infection. Am Surg 66:145–152PubMedGoogle Scholar
  17. 17.
    D.rffel T, Wruck T, Rückert RI et al (2000) Vascular complications in acute pancreatitis assessed by color duplex ultrasonography. Pancreas 21:126–33CrossRefGoogle Scholar
  18. 18.
    Kinney TP, Freeman ML (2008) Recent advances and novel methods in pancreatic imaging. Minerva Gastroenterol Dietol 54:85–95PubMedGoogle Scholar
  19. 19.
    Choueiri NE, Alkaade S, Burton FR, Balci NC (2010) Advanced imaging of chronic pancreatitis. Curr Gastroenterol Rep 12:114–120PubMedCrossRefGoogle Scholar
  20. 20.
    Aheed JS, Miller F (2007) Chronic pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28:384–394CrossRefGoogle Scholar
  21. 21.
    Kahl S, Glasbrenner B, Leodolter A et al (2002) EUS in the diagnosis of early chronic pancreatitis: a prospective followup study. Gastrointest Endosc 55:507–511PubMedCrossRefGoogle Scholar
  22. 22.
    Rickes S, Böhm J, Malfertheiner P (2006) SonoCT improves on conventional ultrasound in the visualization of the pancreatic and bile duct: A pilot study. J Gastroenterol Hepatol 21:552–555PubMedCrossRefGoogle Scholar
  23. 23.
    Martinez-Noguera A, D’Onofrio M (2007) Ultrasonography of the pancreas. 1. Conventional imaging. Abdom Imaging 32:136–149PubMedCrossRefGoogle Scholar
  24. 24.
    Bolondi L, Priori P, Gullo L et al (1987) Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis. Pancreas 2:222–229PubMedCrossRefGoogle Scholar
  25. 25.
    Homma T, Harada H, Koizumi M (1997) Diagnostic criteria for chronic pancreatitis by the Japan Pancreas Society. Pancreas 15:14–15PubMedCrossRefGoogle Scholar
  26. 26.
    Ring EJ, Eaton SB, Ferrucci JT, Short WF (1973) Differential diagnosis of pancreatic calcification. Am J Roentgenol Radium Ther Nucl Med 117:446–452PubMedGoogle Scholar
  27. 27.
    Kim HC, Yang DM, Jin W et al (2010) Color Doppler twinkling artifacts in various conditions during abdominal and pelvic sonography. J Ultrasound Med 29:621–632PubMedGoogle Scholar
  28. 28.
    Niederau C, Grendell JH (1985) Diagnosis of chronic pancreatitis. Gastroenterology 88:1973–1995PubMedGoogle Scholar
  29. 29.
    Hessel ST, Siegelman SS, McNeil BJ et al (1982) A prospective evaluation of computer tomography and ultrasound of the pancreas. Radiology 143:129–133PubMedGoogle Scholar
  30. 30.
    D’Onofrio M, Zamboni G, Tognolini A et al (2006) Massforming pancreatitis: value of contrast-enhanced ultrasonography. World J Gastroenterol 12:4181–4184PubMedGoogle Scholar
  31. 31.
    Rickes S, Unkrodt K, Neye H et al (2002) Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol 37:1313–1320PubMedCrossRefGoogle Scholar
  32. 32.
    Rickes S, Unkrodt K, Wermke W et al (2000) Evaluation of Doppler sonographic criteria for the differentiation of pancreatic tumours. Ultraschall in Med 20:253–258CrossRefGoogle Scholar
  33. 33.
    Rickes S, Mönkemüller K, Malfertheiner P (2006) Contrastenhanced ultrasound in the diagnosis of pancreatic tumors. J Pancreas 7:584–592Google Scholar
  34. 34.
    Rickes S, Unkrodt K, Ocran K et al (2003) Differentiation of neuroendocrine tumours from other pancreatic lesions by echo-enhanced power Doppler sonography and somatostatin receptor scintigraphy. Pancreas 26:76–81PubMedCrossRefGoogle Scholar
  35. 35.
    Neuzillet C, Lepère C, El Hajjam M et al (2010) Autoimmune pancreatitis with atypical imaging findings that mimicked an endocrine tumor. World J Gastroenterol 21:2954–2958CrossRefGoogle Scholar
  36. 36.
    Khan KJ (2010) Prevalence, diagnosis, and profile of autoimmune pancreatitis presenting with features of acute or chronic pancreatitis. Clin Gastroenterol Hepatol 8:639–640PubMedCrossRefGoogle Scholar
  37. 37.
    Numata K, Ozawa Y, Kobayashi N et al (2004) Contrast enhanced sonography of autoimmune pancreatitis. Comparison with pathologic findings. J Ultrasound Med 23:199–206PubMedGoogle Scholar
  38. 38.
    Habashi S, Draganov PV (2009) Pancreatic pseudocyst. World J Gastroenterol 15:38–47PubMedCrossRefGoogle Scholar
  39. 39.
    Rickes S, Wermke W (2004) Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound. J Gastroenterol Hepatol 19:761–766PubMedCrossRefGoogle Scholar
  40. 40.
    D’Onofrio M, Barbi E, Dietrich C et al (2011) Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol doi:10.1016/j.ejrad.2011.01.053Google Scholar
  41. 41.
    Rickes S, M.nkemüller K, Peitz U et al (2006) Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst. Scand J Gastroenterol 41:989–992PubMedCrossRefGoogle Scholar
  42. 42.
    Procacci C, Graziani R, Zamboni G et al (1997) Cystic dystrophy of the duodenal wall: radiologic findings. Radiology 205:741–747PubMedGoogle Scholar
  43. 43.
    Rickes S, Kolfenbach S, Kahl S, Malfertheiner P (2004) Gastrointestinal bleeding and pancreatic pseudocysts. J Gastroenterol Hepatol 19:711PubMedCrossRefGoogle Scholar
  44. 44.
    Rickes S, Mönkemüller K, Venerito M, Malfertheiner P (2006) Pseudoaneurysm of the splenic artery. Dig Surg 23:156–158PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  1. 1.Department of Internal MedicineAMEOS Hospital St. SalvatorHalberstadtGermany

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