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PAEDIATRIC PANCREATIC ABNORMALITIES
Category: Diagnostic Radiology
Abstract : PANCREAS - Normal appearances The acoustic characteristics of the pancreas vary with age. Pancreatic echogenicity is quite variable and is occasionally hypoechoic in neonates compared with the adult gland. In older children echogenicity is equal to or slightly greater than that of the liver. The pancreas is relatively larger in young children than in adults, gradually increasing with age, reach
PANCREAS - Normal appearances
The acoustic characteristics of the pancreas vary with age. Pancreatic echogenicity is quite variable and is occasionally hypoechoic in neonates compared with the adult gland. In older children echogenicity is equal to or slightly greater than that of the liver. The pancreas is relatively larger in young children than in adults, gradually increasing with age, reaching adult size in late teens.
The pancreatic duct is often visualized but should not be greater than 2 mm in width. The relative hypoechogenicity and relatively larger size of the normal pancreas in childhood should not be misinterpreted as a sign of probable pancreatitis when scanning a child with abdominal pain.
Pathology of the pancreas
Pancreatic abnormalities are relatively uncommon in childhood. Most ultrasound abnormalities are the result of infiltrative processes associated with other syndromes or diseases. Focal pancreatic lesions are rare. Ultrasound is an ideal investigation for evaluating the paediatric pancreas, as a high-frequency probe demonstrates excellent detail. A water-based drink may be given to provide an acoustic window. In cases of blunt injury to the abdomen with suspected pancreatic damage, CT is the imaging modality of choice in the acute situation, although sonography should be used during follow-up to detect the presence of a pseudocyst.
Paediatric pancreatic abnormalities
Increased echogenicity
Cystic fibrosis
—fatty replacement of the pancreas, calcifications, ectatic pancreatic duct, coarse texture, cysts
Pancreatitis
—hereditary
—trauma (physical abuse, road traffic accident)
—congenital anomaly, e.g. choledochal cyst
—drug toxicity
—viral and parasitic infection
Haemochromatosis
—pancreatic fibrosis, iron deposition in liver and pancreas
Focal lesions
Cysts
—isolated congenital cyst
—autosomal dominant polycystic disease
—von Hippel–Lindau disease
—Meckel–Gruber syndrome
Solid lesions
—primary pancreatic neoplasms are very rare in children
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