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Reduced echogenicity of the pancreas. Ultrasound result: decreased echogenicity of the pancreas. Hypoechoic formation with the blood flow locus of the pancreas

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Hypoechoic formation in the head of the pancreas

Hypoechoic formation

Instrumental diagnostics using ultrasound scanning (ultrasound), also called ultrasonography, can detect areas with different acoustic densities in internal organs and cavities - hyperechoic or hypoechoic formation.

What does hypoechoic formation mean?

Local hypoechoic formation in a particular organ, in contrast to hyperechoic formation, is the result of lower echogenicity of tissues - in comparison with the parameters of the acoustic density of healthy tissues of the organ. That is, this area weakly reflects the ultrasonic signal directed at it (in the frequency ranges 2-5, 5-10 or 10-15 MHz). And this is evidence that this formation - from the point of view of its structure - either contains liquid or has a cavity.

A hypoechoic formation is visualized on the screen as gray, dark gray and almost black zones (with hyperechogenicity the zones are light, often white). To decipher an ultrasound image, there is a scale of six categories of gray Gray Scale Imaging, where each pixel of the image of a hypoechoic formation obtained on the monitor - depending on the strength of the ultrasound signal returning to the sensors - represents a specific shade of gray.

The results of an ultrasound examination, deciphered by ultrasound diagnosticians (sonographers), are studied by doctors of a specific profile (endocrinologist, gastroenterologist, urologist, nephrologist, oncologist, etc.) and compared with the indicators of tests taken by patients and the results of other studies.

In many cases, differential diagnosis is required, for which, in addition to ultrasound, other hardware methods for visualizing pathology are used (angiography, color Dopplerography, CT, MRI, etc.), and histological examination of biopsy specimens is also carried out.

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Pathology of the pancreas on ultrasound (lecture at Diagnostic) - Diagnostic

Click on pictures to enlarge.

Single small simple cysts occur as incidental findings in the healthy pancreas. In chronic pancreatitis, small simple cysts are quite common. If a cyst is suspected, note the enhancement of the contour of the far wall and the effect of signal enhancement in the tissue behind. Simple cysts are isolated from the parenchyma by a smooth thin wall. There should be no partitions or wall irregularities inside; the contents of the cyst are anechoic. Simple cysts are always benign. But, if the cyst is not obviously “simple”, further investigation is required.

Important!!! Simple pancreatic cysts are common, but don't forget about cystic tumors. Cancer is the most dangerous disease of the pancreas.

There are two types of pancreatic cystic tumors: benign microcystic adenoma and malignant macrocystic adenoma. Microcystic adenoma consists of many small cysts and appears as a dense formation on ultrasound. Macrocystic adenoma usually includes fewer than five cysts larger than 20 mm. Sometimes polypoid formations can be seen in such cysts.

With pancreatitis, pancreatic secretions digest surrounding tissue and pseudocysts form. Pseudocysts from the abdominal cavity can extend into the chest and mediastinum. Pseudocysts are often found in patients who have suffered acute pancreatitis (see below).

As a result of pronounced dilation of the pancreatic duct, retention pseudocysts may form distal to the site of obstruction.

Acute pancreatitis on ultrasound

Acute pancreatitis is a severe complication of gallstone disease or a consequence of toxic effects, such as alcohol.

Mild pancreatitis is not visible on ultrasound (CT is a more sensitive method). Severe pancreatitis is easily detected by ultrasound. When an unusually clear and contrasting pancreas stands out from the surrounding tissue, edema of the parenchyma and surrounding fatty tissue can be assumed. If a thin layer of free fluid is visible around the pancreas, along the stomach, at the hilum of the liver and spleen, pancreatitis can be confidently diagnosed.

Almost all pancreatic tumors are hypoechoic compared to the normal pancreas. It is impossible to distinguish between focal pancreatitis and pancreatic tumor using ultrasound alone. A tumor and pancreatitis can be combined.

In severe cases of pancreatitis, pancreatic fluid digests surrounding tissue, forming pseudocysts. Such cysts can be single or multiple. They may increase in size and rupture.

On ultrasound, pseudocysts are defined as oval or round hypoechoic formations with clear contours. In the early phases of cyst formation, it is a semi-liquid formation and has a complex echostructure with internal reflections and unclear contours. Later, due to autolytic processes and sedimentation of a suspension from blood and pus, clear signs of liquid contents appear and a false capsule with smooth walls is formed. Infection of pseudocysts often occurs, then internal echo structures or thin delicate septa can be detected. When a cyst is detected, it is important to trace the connection of the cyst with the duct, as this is important for determining treatment tactics. When a pseudocyst is more than 10 cm in size, difficulties arise in determining its source.

Chronic pancreatitis on ultrasound

Chronic pancreatitis can have various manifestations, from an almost normal gland to severe atrophy and calcification of the parenchyma. The pancreas becomes thinner, the pancreatic duct sometimes seems slightly dilated, and the contour of the gland is often uneven with jagged edges. Simple cysts are common and can become quite large. Often stones form in the pancreatic duct.

Calcifications in the pancreas on ultrasound

Important!!! If there is dilatation of the pancreatic duct, you should look for stones in the pancreatic duct and in the common bile duct.

Calcifications inside the pancreas can give an acoustic shadow, but if they are small, they appear as a separate bright echostructure without an acoustic shadow. In chronic pancreatitis, calcifications are distributed diffusely throughout the pancreas. Stones in the duct are located along the duct. Gallstones in the distal common bile duct may be mistaken for calcifications in the pancreas. Calcifications are clearly visible on CT, and for non-calcified stones, MRI or ultrasound is preferable.

Photo. A - There is a small stone in the dilated duct. B - In the dilated pancreatic duct there is a row of several stones with shadowing behind. B - A patient with chronic pancreatitis has huge stones in the dilated duct. Note the intense shading behind.

Dilated pancreatic duct on ultrasound

The internal diameter of the normal pancreatic duct is less than 3 mm. The duct is better visualized with transverse scanning in the middle third of the body of the pancreas. In order to make sure that you have found the duct, you need to see the pancreatic tissue on both sides of it. The splenic vein posteriorly or the gastric wall anteriorly may be falsely interpreted as the pancreatic duct.

The walls of the pancreatic duct should be smooth and the lumen should be clean. When the duct is dilated, the walls become uneven; scan not only the head of the pancreas, but also the entire biliary tract.

The main causes of dilatation of the pancreatic duct: tumor of the head of the pancreas or ampulla of Vater's papilla (combined with jaundice and dilatation of the biliary tract); stones of the common bile or pancreatic duct; chronic pancreatitis; postoperative adhesions.

Pancreatic tumors on ultrasound

In most (50-80%) cases, the tumor affects the head of the pancreas. Tumors of the head compress the common bile duct. In cancer of the pancreas, the contour of the pancreas is unclear; local enlargement or bulging of the gland is characteristic, sometimes penetrating into the surrounding tissue in the form of tongues or pseudopodia.

In most cases, a pancreatic tumor is a hypoechoic formation, almost devoid of internal echo structures. However, there are tumors with diffusely scattered echo signals and with high-intensity echo signals in the center and their absence in the periphery. Despite the fact that the boundary between the tumor and the rest of the parenchyma of the gland is unclear, it can always be approximately drawn due to the difference in the echogenicity of normal tissue and the tumor focus.

Although the hypoechoic structure of the tumor, especially in the absence of small areas of increased density in it, resembles that of cysts, the absence of the effect of distal enhancement allows us to exclude the liquid nature of the formation. In addition, cysts are characterized by a much smoother and clearer border.

With tumors of the head of the pancreas, the common bile and pancreatic duct is often dilated, unlike chronic pancreatitis, its walls are smooth and not compacted.

Important!!! Visualization of the main pancreatic duct within the hypoechoic zone is in favor of local edema and against tumor.

Sometimes, with pancreatic cancer, typical signs of chronic pancreatitis are revealed, as well as pseudocysts distal to the site of tumor obstruction. This is a consequence of obstruction. Intrahepatic metastases, enlarged celiac, periportal and retroperitoneal lymph nodes indicate cancer.

Take care of yourself, Your Diagnosticer!

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Types of hyperechoic inclusions in the pancreas and their significance

29.06.2017

Often, in the final description of an ultrasound examination of the pancreas, many patients can read that there are hyperechoic inclusions in the pancreas. The presence of such a symptom may indicate the development of a serious pathological disorder in the organ under study. In this review, we will take a closer look at what hyperechoic inclusions are and what types of them exist.

The concept of hyperechogenicity

Have you been treating PANCREATITIS for many years without success?

Chief gastroenterologist of the Russian Federation: “You will be amazed at how easy it is to get rid of pancreatitis with...

Terminology such as the level of echogenicity of internal organs is used only for ultrasound examinations and denotes the degree to which the organs under study can reflect an ultrasonic wave directed at it through a special sensor of an ultrasound machine.

Each organ has its own norm for this indicator, which depends on its level of density. Organs with greater density will have a higher level of echogenicity than organs with a looser structure.

An increase in the level of echogenicity of the pancreas indicates the proliferation of fibrous tissue and the development of hyperechogenicity.

During the development of hyperechogenicity in the pancreas, the following types of hyperechoic inclusions can be visualized:

Small pinpoint hyperechoic inclusions representing calcifications. As is known, the functional ability of the pancreas is to produce special enzymes, a small part of which can be retained in the lumens of small glands. Over time, calcium salts begin to deposit in these gaps, which leads to the formation of stones, or calcifications. People usually call them small pebbles, which in themselves do not pose a huge danger. If the conclusion of an ultrasound examination indicates that the parenchyma has a moderately increased level of echogenicity, then we are talking about the development of a chronic inflammatory process, namely chronic pancreatitis.
Hyperechoic linear inclusions, which are not a specific sign for a particular pathological process, representing the presence of dense tissue, in most cases, the formation of foci of replacement of healthy tissue with connective tissue.

The presence of hyperechoic inclusions can be determined with the development of the following pathological disorders:

lipomatous lesion of the pancreas, which is a process of replacement of glandular tissues with fat, in which this organ does not increase in size;
development of acute pancreatitis accompanied by swelling of the gland, manifested by sharp pain in the abdominal area, discharge of vomit and the development of diarrhea;
the occurrence of tumor-like neoplasms, accompanied by pallor of the skin, a sharp decrease in body weight, stool disorders and loss of appetite;
the development of pancreatic necrosis, characterized by the death of tissue of a parenchymal organ at the cellular level, manifested by the occurrence of unbearable pain in the abdominal area, which can provoke a painful shock, as well as the uninterrupted process of vomiting and diarrhea;
fibrous lesion of the pancreas, characterized by the proliferation of connective tissues.

The occurrence of hyperechogenicity in the organ under study can also be temporary, manifested in the following cases:

against the background of the development of infectious pathology of the upper respiratory tract, such as influenza, pneumonia, or one of many infectious pathologies;
after a radical change in diet;
with a sharp change in lifestyle;
when performing an ultrasound after a hearty breakfast or lunch.

In such cases, the level of echogenicity increases to a moderate level, while hyperechogenicity in pathological disorders has higher outcome rates.

Types of hyperechoic inclusions

Hyperechoic inclusions in the parenchymal organ under study can be:

pseudocyst, which is a liquid formation that occurs after elimination of an acute form of pancreatic lesion of the gland, is characterized by the formation of an uneven and jagged contour;
as mentioned above, these can be calcifications or small pebbles;
metastatic tumors;
certain segments of adipose or connective tissue;
cystic fibrous areas of gland tissue.

Treatment methods

For the prevention and treatment of pancreatic diseases, our readers recommend Monastic tea. This is a unique product that includes 9 biologically active medicinal herbs useful for the pancreas, which not only complement, but also enhance each other’s actions. Monastic tea will not only eliminate all symptoms of inflammation of the gland, but will also permanently eliminate the cause of its occurrence.

The treatment regimen for increased echogenicity of the pancreas should be prescribed only by a highly qualified gastroenterological specialist.

To begin developing the most effective treatment regimen, a specialist must initially establish the true cause that provoked the formation of hyperechogenicity.

If the formation of this symptomatology was provoked by the development of an acute form of pancreatitis, then therapeutic treatment should consist of taking special medications, the pharmacological action of which is aimed at reducing the production of hydrochloric acid in the gastric cavity and inhibiting enzymatic activity in the pancreatic cavity.

When this ultrasound indicator increases, caused by the development of lipomatous lesions, experts recommend following a special dietary diet that excludes all foods containing animal fats.

If the etiological factor is the formation of calcifications or the development of fibrous lesions of the organ being studied, then experts initially prescribe adherence to a strict dietary diet, and in the absence of positive dynamics, doctors question the treatment of the pathology through surgical intervention.

The formation of reactive pancreatic lesions requires therapeutic elimination of the underlying pathology in compliance with a special dietary diet.

It is important to remember that an increased level of echogenicity is just a symptom of ultrasound examination of a parenchymal organ. To prescribe therapeutic treatment, specialists do not need only these ultrasound results. In order to develop the most effective tactics for eliminating pathology, it is necessary to undergo a number of additional examinations, based on the results of which the tactics of therapeutic procedures will be built.

What to do if you have pancreatitis?

Ignoring or improperly treating pancreatitis can lead to dire consequences:

diabetes;
liver and kidney failure;
oncology, which threatens partial or complete removal of the pancreas.

Not to mention strict diets, constant intake of enzymes and periods of exacerbation, when there is no longer any strength to live... “But it is possible to forget about pancreatitis forever,” says the chief gastroenterologist of the Russian Federation...

pankreatit03.ru

What do you need to know about hypoechoic formation?

By hypoechoic formation we mean that the organ contains nodes that have a lower density than the tissues that are located next to this structure. This formation can be either a specific disease or a completely normal phenomenon. That is why many people want to know what a hypoechoic formation is, as well as how it can be detected.

Ultrasound of internal organs is based on the property of reflection of sound waves of a certain frequency from tissues having a high density

Ultrasound of internal organs is based on the property of reflection of sound waves of a certain frequency from tissues that have a high density. However, tissues that have liquid inside have this property to a lesser extent. The device sends a sound vibration to a specific organ, which returns when reflected from the tissue. The device converts the received data into an image that is displayed on the display. After this, the sonologist evaluates the received visual information. But it should be borne in mind that the assessment is always subjective, since it depends on the ultrasound frequency used, the quality of the equipment, the characteristics of the patient and the qualifications of the specialist.

If there is advance information about the patient’s symptoms and chronic pathologies, this may be the reason for examining the organs, which are also checked for the presence of hypoechoic formations in them.

Hypoechoic nodes are usually cystic formations. It follows from this that a cavity may have formed in the organ, which has thin walls and is filled with liquid. But to confirm this diagnosis, an additional biopsy is performed.

Very important factors are the shape and size of the node. If the hypoechoic area has rounded contours, it means that some types of tumors may be present in the organ being examined. Darkened areas revealed during the study are sometimes normal and indicate a benign formation, for example in the breast during lactation. Hypoechoic formation can be located in various organs: pancreas, liver, kidneys, uterus, ovaries, mammary gland, etc.

Hypoechoic formations in the pancreas, kidneys and liver

During an ultrasound of the pancreas, tissues that have low density can be detected. This makes it possible to diagnose various pathologies.

If a darkened echo structure and blurred boundaries of the formation are observed on the monitor, this indicates that there are cancer metastases in the organ. If on the display during examination of the pancreas the formation is homogeneous, has a clear round shape and an even contour, this indicates the presence of a cyst.

With a cancerous tumor, you can see thin processes that run along the edges of the formation. The pancreas in the picture is enlarged in size, and the large vessels are displaced and deformed. Using a Doppler study, this diagnosis can be confirmed if normal blood flow cannot be detected in these areas.

Very important factors are the shape and size of the node

If hypoechoic areas were found in the kidney tissue, this indicates a tumor or cyst. When a tumor forms, inflammation of the lymph nodes often occurs in the area of the groin and peritoneum. When performing a Doppler study in a hypoechoic node, a lack of internal blood flow may be detected.

If a cyst has formed, this can be determined by its homogeneous structure and clear boundaries, while the tumor on the monitor is indicated by ragged, fuzzy contours. To treat the kidneys and accurately diagnose a possible disease, ultrasound alone is not enough. To do this, a comprehensive clinical examination is performed, which includes a blood test, biopsy, computed tomography and angiography.

A hypoechoic node found in the liver indicates the occurrence of a cyst, tumor and other pathologies. In order for the liver examination to be as accurate as possible, the patient needs to prepare for the examination in a certain way. Hypoechoic nodes usually indicate the presence of the following pathologies:

with obesity, healthy tissue areas remain;
cirrhosis of the liver;
inflammation;
a blood clot has formed in the portal vein;
metastases from carcinoma;
tumors, adenomas, cysts.

Uterus and ovaries

Detection of hypoechoic formations in the uterus during ultrasound usually indicates the development of a tumor. But it can be either malignant or benign. Therefore, its identity can only be determined through differential diagnosis. For example, the presence of fibroids (benign formation) is indicated by a darkened area that can be seen on the wall of the uterus. A hypoechoic formation in case of inflammation of the uterus has a distinctive echostructure.

If the hypoechoic zone has an unclear shape, then this may indicate carcinoma. During this, an enlarged uterine cavity and the presence of a lateral shadow can be observed. If formations were detected near the fertilized egg and have a low density, then this is a harbinger of an incipient miscarriage.

This indicates that blood is accumulating under the fetus, in which case immediate medical intervention is necessary.

If hypoechoic zones were found in the ovaries, this is a consequence of the presence of the luteal body, vascular formation or cyst. Very rarely, low-density formations in the ovaries occur with cancerous formations. During ultrasound of the ovaries, a woman’s reproductive ability and her age play an important role. For all women who can give birth and conceive a baby, a heterogeneous structure is the norm. Conversely, the structure evens out during menopause.

Human body (video)

Hypoechoic zones in the mammary gland

To identify a hypoechoic area in the chest with maximum accuracy, the sonologist must take into account the following factors when performing an ultrasound:

level of color uniformity;
the condition of areas located next to the hypoechoic formation;
shape and contour;
the presence of side shadows;
formation of blood vessels in breast tissue.

Detection of hypoechoic formations in the uterus during ultrasound usually indicates the development of a tumor

If breast tissue has areas in which the density is reduced, this may indicate the presence of a malignant neoplasm in the breast. So, for example, if a dark spot with uneven contours is visible, then it is most likely carcinoma. This dangerous formation has an acoustic shadow, and its structure is heterogeneous. However, it should be borne in mind that similar symptoms occur quite often in other cases. An ordinary cyst is usually identified by its round shape, as well as clear contours. Suspicion of the presence of a cancerous tumor usually arises as a result of the identification of formations with thick walls and growths inside the cavity being examined.

Enlarged liver and pancreas are typical manifestations

If, during an ultrasound of the pancreas and comparing it with the liver, it was determined that the gland has a hypoechoic structure, this may indicate acute pancreatitis. Also, acute pancreatitis is characterized by a loss of clarity of the contour of the gland, which does not prevent the pancreas from being well visualized. Gradually, as the disease progresses, the contour line continues to disappear.

Hypoechogenicity of the gland can be focal or diffuse. With diffuse changes, it is expressed almost uniformly throughout the pancreas, with minor heterogeneous areas of the organ itself or its contour. But with focal changes, you can observe areas of irregular shape, which may not have clear contours, but may, on the contrary, be clearly detailed.

Sometimes a picture may occur in which, during examination of an organ, hypoechoic zones are visible among many hyperechoic fields. This condition of the pancreas occurs if pronounced fibrolipomatous changes occurred in the gland, against the background of which an inflammatory-destructive process later developed.

As acute pancreatitis progresses, the size of the organ increases, and its heterogeneity and hypoechogenicity become more noticeable. And in many cases, this property is reduced so much that it becomes almost impossible to distinguish the pancreas from the adjacent portal and splenic vein.

Also, areas of reduced echogenicity will be detected in hemorrhagic pancreatitis, when the echostructure of the gland becomes heterogeneous due to its increase in size and the formation of edema in the adjacent soft tissues.

If studies are carried out on a highly sensitive scanner, then in almost 90% of cases, sonography of the pancreas allows us to examine an area of reduced echogenicity that is not associated with diseases of the pancreas. This area is the main pancreatic duct, visualized as a hypoechoic tube with a diameter of 1.3 mm. With age, the duct widens, but normally should not be wider than 2 mm. Sometimes the pancreatic duct is visualized as a thin line.

What you need to know about hypoechoic formation

Determination of hypoechoic formation using ultrasound

Thyroid nodules (video)

Hypoechoic formations in the pancreas, kidneys and liver

During an ultrasound of the pancreas, tissues that have low density can be detected. This makes it possible to diagnose various pathologies.

Very important factors are the shape and size of the node

with obesity, healthy tissue areas remain;
cirrhosis of the liver;
inflammation;
a blood clot has formed in the portal vein;
metastases from carcinoma;
tumors, adenomas, cysts.

Uterus and ovaries

This indicates that blood is accumulating under the fetus, in which case immediate medical intervention is necessary.

Human body (video)

Hypoechoic zones in the mammary gland

To identify a hypoechoic area in the chest with maximum accuracy, the sonologist must take into account the following factors when performing an ultrasound:

level of color uniformity;
the condition of areas located next to the hypoechoic formation;
shape and contour;
the presence of side shadows;
formation of blood vessels in breast tissue.

Detection of hypoechoic formations in the uterus during ultrasound usually indicates the development of a tumor

When performing ultrasound diagnostics of the breast in women, the regularity of the menstrual cycle should be taken into account, and this is especially true on the day when the ultrasound is performed. In this case, there is no need to prepare for the examination, since it is carried out immediately after the person contacts the diagnostic center. If areas with hypoechogenicity are identified, it will be necessary to repeat the ultrasound in a month.

Pathology of the pancreas on ultrasound (lecture at Diagnostic)

Click on pictures to enlarge.

Pancreatic cysts on ultrasound

Important. Simple pancreatic cysts are common, but don't forget about cystic tumors. Cancer is the most dangerous disease of the pancreas.

As a result of pronounced dilation of the pancreatic duct, retention pseudocysts may form distal to the site of obstruction.

Acute pancreatitis on ultrasound

Acute pancreatitis is a severe complication of gallstone disease or a consequence of toxic effects, such as alcohol.

In severe cases of pancreatitis, pancreatic fluid digests surrounding tissue, forming pseudocysts. Such cysts can be single or multiple. They may increase in size and rupture.

Chronic pancreatitis on ultrasound

Calcifications in the pancreas on ultrasound

Important. If there is dilatation of the pancreatic duct, you should look for stones in the pancreatic duct and in the common bile duct.

Dilated pancreatic duct on ultrasound

Pancreatic tumors on ultrasound

With tumors of the head of the pancreas, the common bile and pancreatic duct is often dilated, unlike chronic pancreatitis, its walls are smooth and not compacted.

Important. Visualization of the main pancreatic duct within the hypoechoic zone is in favor of local edema and against tumor.

Ultrasound result: decreased echogenicity of the pancreas

One of the main indicators of ultrasound examination of internal organs located in the peritoneal cavity is the level of echogenicity. Any change upward or downward may indicate the development of a severe pathological disorder in the organ under study. In this review, we will take a closer look at why the echogenicity of the pancreas is decreased or increased, what it is and what pathologies can lead to a change in this indicator.

What is echogenicity called and how is it detected on ultrasound?

Have you been treating PANCREATITIS for many years without success?

Chief gastroenterologist of the Russian Federation: “You will be amazed at how easy it is to get rid of pancreatitis simply by cleansing the pancreas of toxins.

The concept of echogenicity refers to the ability of tissues and internal organs to reflect ultrasonic impulses and waves. A reduced level of ultrasound reflection ability is called hypoechogenicity, and an increased level is called hyperechogenicity.

On the monitor screen of an ultrasound machine, this indicator is visualized in the form of a gray scale, which, depending on the state of performance of the organ under study, changes its shade level.

For example, a hypoechoic formation in the pancreas is visualized as one dark gray spot or a black spot. But the average level of this indicator is visualized as a light gray shade of the pancreas with distinct, even contours. An increase in echogenicity, or hyperechogenicity, appears as a lighter area, up to white shades.

It is important to remember that the norm of the pancreas echogenicity indicator corresponds to the level of this indicator of a healthy liver. Any decrease or increase in echogenicity is also always compared with liver parameters.

Causes of pathological changes in the level of echogenicity

The development of the following pathological processes can reduce or increase the level of the ability of the pancreas to reflect ultrasound:

the formation of calcifications, or as they are also called small pebbles in the pancreas;
development of pancreatic pathology (inflammatory process) of an acute or chronic nature;
development of tumor-like neoplasms;
the progressive stage of lipomatosis, that is, the replacement of healthy glandular tissues with fatty tissues;
necrotic lesion of the parenchyma.

The development of each of the above pathological processes is clearly visible on the monitor screen of the diagnostic apparatus.

Types of hypoechoic formations

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Detection of a hypoechoic structure of the pancreas during an ultrasound examination may indicate the development of an acute form of pancreatic damage to this organ. Moreover, the acute form of pancreatitis is accompanied by a loss of clarity of the contours of the gland, which prevents a full examination of the parenchymal organ. Over time, as this pathology progresses, the contour lines of the gland become more and more blurred, until it is completely impossible to visualize them.

In some cases, it is possible to identify individual hypoechoic areas against the background of multiple hyperechogenicity. Such processes can occur when, after intense fibrolipomatous processes in the gland, destructive disorders with an inflammatory nature begin to develop.

The progressive stage of acute pancreatitis contributes to a significant increase in the size of the parenchymal organ, and also acts as an acute factor that reduces echogenicity.

In some cases, echogenicity may be reduced to such an extent that the pancreas is almost impossible to distinguish from the splenic and portal veins.

Zones of hypoechoic formations are also detected during the development of hemorrhagic pancreatitis. Hemorrhagic pancreatitis can not only reduce the level of echogenicity of the organ under study, but also increase it to a significant size and cause an edematous state of the soft tissues adjacent to this organ.

A decrease in the level of pancreatic density can be either diffuse or focal. With a diffuse decrease in the ability to reflect ultrasound, edema occurs when the level of fluid content in the gland increases. This mainly happens with the development of acute pancreatitis, or the manifestation of a severe allergic reaction with existing hypervolemia, that is, an increased level of water content in the body.

The formation of focal hypoechogenicity may be preceded by the following pathological changes:

HOW TO FORGET ABOUT PANCREATITIS FOREVER?

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cystic lesion of the parenchyma;
development of a pancreatic cyst;
the appearance of a tumor-like neoplasm;
an increase in the diameter of the ducts of the gland being studied.

It is important to remember that the focal type of the gland’s ability to reflect ultrasound can be not only reduced, but also increased, depending on what type of tumor-like neoplasm occurs.

Treatment methods

Most often, medications are prescribed, which are based on synthetic or natural enzymes that help reduce the overall level of load on the affected organ, or, for a certain period of time, perform its functions in the absorption of nutritional components from food taken.

Antispasmodic drugs will help reduce pain and eliminate the feeling of unpleasant discomfort.

As a complement to the main treatment, a strict dietary diet is prescribed. Exceptions should be made to the following ingredients:

alcohol-containing and carbonated drinks;
fatty foods;
semi-smoked and smoked food products;
fried and heavy foods.

It is worth remembering that the speed of the recovery process of the affected organ completely depends on the strict adherence to the dietary regimen, because basically all pathological disorders in the pancreas occur against the background of poor nutrition and consumption of excessive levels of fast carbohydrates and fast food.

Nausea, abdominal pain, high temperature, intoxication - this is all pancreatitis. If the symptoms are obvious, your pancreas may no longer be able to function normally. You are not alone, according to statistics, up to 15% of the entire population of the planet suffers from problems with the pancreas.

How to forget about pancreatitis? The chief gastroenterologist of the Russian Federation, Vladimir Ivashkin, talks about this...

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Encyclopedia of Ultrasound and MRI

What is this hypoechoic formation?

Don’t be alarmed when you hear the term “hypoechogenicity” from your doctor. This word does not denote any diagnosis, but describes a structure with a lower density than all neighboring tissues. Such formation can be either normal or pathological. It all depends on the organ in question.

More about the phenomenon of “hypoechogenicity”

The examination technique using ultrasound is that using special equipment, sound vibrations of a certain frequency are generated, sent to the organs, and then a response is received, that is, reflected sound, echo. The structure of organs can be judged by acoustic density (echogenicity).

Some formation in the body may show reduced acoustic density and appear darker on the screen than neighboring tissues. This phenomenon is called hypoechogenicity, that is, reduced density. In this area, ultrasound progresses more slowly. Most often, this phenomenon has a liquid structure: it could be, for example, a cyst. The doctor will not be able to immediately give an accurate diagnosis.

The fact is that the formation can be round or with uneven edges. Round can be:

A structure with uneven outlines can be not only a cyst, but also an adenosis, fibroadenoma or tumor. However, only a biopsy, as well as cystoscopy, laparoscopy or bronchoscopy, can definitely determine the nature of this phenomenon.

What is a hypoechoic formation (node) in various organs?

If the examination concerns the thyroid gland, then there is no need to immediately panic and run to the oncologist. As a rule, only 5% of patients find out that the emerging formation (hypoechoic node) is an oncological pathology. Most often, the finding turns out to be a cyst, vascular formation, or fluid structure.

Normal thyroid gland on ultrasound

First of all, you need to go for a consultation with an endocrinologist and get tested for hormones (the doctor will tell you more about which when writing a referral). If nothing terrible turns up, it is advisable to repeat all the tests after six months. A hypoechoic nodule that grows or does not change in size will have to be examined with a biopsy.

When a node is found in the uterus, it is most likely a tumor. You just need to find out whether it is benign or malignant. If the formation also has an echo structure inside, then we are talking about inflammation of the uterus.

The phenomenon of reduced echogenicity is very important in case of pregnancy:

if such an area is localized near the embryo, this indicates an impending miscarriage.

A hypoechoic node can also be detected in the mammary gland during mammography. As a rule, such areas can be:

glandular carcinoma. It has fuzzy, uneven outlines, there is a shadow, and a heterogeneous structure.
adenosis.
typical cyst. In this case, the contours will be clear and the shape will be round.
an atypical cyst that can be malignant.
fibroadenoma. It has smooth, clear contours and is similar to malignant tumors.

If such formations are detected, it is necessary to repeat the study a month later and, depending on the results, go for a biopsy.

If a hypoechoic node is found in the ovaries, then do not worry too much: extremely rarely it can turn out to be an oncological pathology. Most often, the phenomenon is a cyst, follicle, luteal body or vascular formation.

Follicular ovarian cyst

But in the case of a kidney, such a node can be either a cyst (then it has a clear contour, homogeneous structure) or a tumor (malignant, if enlargement of the retroperitoneal lymph nodes is detected). As a rule, the patient is immediately sent for additional examinations to accurately establish the nature of the finding.

Nodes in other organs

The presence of nodes in the pancreas suggests that the doctor may be dealing with the following phenomena:

Cysts (especially if they have smooth outlines and a homogeneous structure).
Pancreatitis or fibrolipomatous processes.
Metastases (the boundaries will be blurred).
Oncology.

To confirm the diagnosis, you will have to undergo not only an ultrasound of the organ, but also a Doppler ultrasound.

If a structural disorder is found in the liver, the pathologies may be as follows:

A consequence of cirrhosis, when the nodes have a round or bumpy shape.
Cyst.
Thrombosis.
Abscess.
A consequence of fatty infiltration of the liver, when the hypoechoic node is a particle of normal tissue.
Hyperplasia or adenoma.
Oncology and metastases.

Again, additional research is needed for an accurate diagnosis.

Conclusion

Such a hypoechoic formation, depending on the organ being examined, can be either almost any pathology or a natural phenomenon. Most often, cysts or tumors are detected, but sometimes these can be phenomena that need to be urgently operated on or treated with courses of medication. Ultrasound alone cannot give an accurate diagnosis, so for all the recommendations and drawing up a treatment plan, the doctor will have to send the patient for a number of additional examinations.

Hypoechoic formation

What does hypoechoic formation mean?

Local hypoechoic formation in a particular organ, in contrast to hyperechoic formation, is the result of lower echogenicity of tissues - in comparison with the parameters of the acoustic density of healthy tissues of the organ. That is, this area weakly reflects the ultrasonic signal directed at it (in the frequency ranges 2-5, 5-10 or MHz). And this is evidence that this formation - from the point of view of its structure - either contains liquid or has a cavity.

Causes of hypoechoic formation

As an indicator of ultrasonography, a hypoechoic formation can have any location. The causes of hypoechoic formation are also different and completely depend on the etiology and pathogenesis of the diseases that develop in patients.

For example, a hypoechoic formation in the pancreas is considered a diagnostic criterion for identifying pathologies such as cysts, hemorrhagic pancreatitis, mucinous cystadenoma (which is prone to malignancy), adenocarcinoma of the head of the pancreas, and metastases from malignant tumors of other organs.

Hypoechoic formation in the liver and gallbladder

Healthy liver tissue is moderately hyperechoic, and hypoechoic formation in the liver can occur in cirrhotic lesions; focal steatosis; cysts (including Echinococcus multilocularis); biliary abscess; hepatocellular adenoma; focal parenchymal hyperplasia; hepatoma and small cholangiocellular adenocarcinoma.

Hypoechoic formations are also visualized in cases of diffuse metastases of pancreatic, ovarian, mammary gland, testicular, and gastrointestinal cancer spreading to the liver.

In the ultrasound diagnosis of gallbladder pathologies, the structure of its walls is of particular importance, since in the absence of damage to the organ they are visualized in the form of three layers: external and internal hyperechoic and middle hypoechoic.

Among the causes that cause hypoechoic formation in the gallbladder are polyps, adenocarcinoma (with an intact outer layer of the bladder), lymphomas (tumors of the lymph nodes), and angiosarcoma.

Hypoechoic formations of the spleen

Normally, the echogenicity of the spleen is uniform, although slightly higher than that of the liver. But due to the high vascularization, ultrasound of the spleen is performed with a contrast agent, which accumulates in the parenchyma and makes it possible (at the end of the parenchymal phase) to visualize focal lesions and hypoechoic formations of the spleen.

Such formations include:

acute intraparenchymal hematoma due to rupture of the spleen (due to abdominal trauma);
hemangiomas (benign vascular formations) with splenomegaly;
splenic infarctions (infiltrative or hematological);
spleen lymphoma;
metastases of various origins (most often soft tissue sarcoma, osteosarcoma, kidney, breast or ovarian cancer).

As experts note, echinococcal, tapeworm and dermoid cystic formations of the spleen can have a mixed echostructure.

Hypoechoic formation in the kidney, adrenal glands and bladder

A hypoechoic formation in the kidney can be detected when inclusions in the parenchyma include cystic formations (including low-quality ones), hematomas (in the initial stages), pyogenic perinephric abscesses (at the stage of necrosis) or cavernous tuberculosis of the kidney.

According to endocrinologists, detecting a hypoechoic formation of the adrenal gland is not an easy task, and ultrasound, unfortunately, does not always cope with it. For example, verification of the diagnosis of adenoma in primary aldosteronism, as well as pathological proliferation of adrenal cortex cells in hypercortisolism (Cushing's disease) is based on symptoms. Ultrasound accurately detects a fairly large pheochromocytoma, as well as lymphoma, carcinoma and metastases. So, it is most advisable to examine the adrenal glands using CT and MRI.

With the development of benign leiomyoma, transitional cell carcinoma of the bladder or pheochromocytoma (paraganglioma) of the bladder, which is accompanied by arterial hypertension and hematuria, an ultrasound examination visualizes a hypoechoic formation in the bladder.

Hypoechoic formation in the abdominal cavity and pelvis

Pathologies localized in the abdominal cavity, in particular in the intestinal section of the gastrointestinal tract, can be easily examined by ultrasound: the diseased empty intestine has thickened hypoechoic walls, contrasting with the surrounding hyperechoic adipose tissue.

The far from complete list of reasons causing a hypoechoic formation in the abdominal cavity visualized by ultrasound includes:

a hernia protruding into the inguinal canal;
intra-abdominal hematomas (traumatic or associated with coagulopathies);
serous and purulent phlegmon of the peritoneum or retroperitoneum;
abscess of the terminal ileum with transmural ileitis (Crohn's disease);
inflammation of the mesenteric lymph nodes (mesenteric lymph nodes);
B-cell non-Hodgkin's lymphoma or Burkitt's lymphoma;
metastasis to the visceral lymph nodes of the abdominal cavity;
carcinoma of the cecum, etc.

Ultrasound of the pelvic organs and uterus reveals formations with low acoustic density in women - in the presence of fibroids, adenomas, cysts or endometriosis of the uterus; functional or dermoid cysts of the appendages. A hypoechoic formation in the ovary occurs with a hemorrhagic cyst, as well as tubo-ovarian abscess (purulent inflammation in the fallopian tubes and ovaries), follicular lymphoma and carcinoma.

In men, pathologies with such a diagnostic indicator are testicular cancer, testicular lymphocele, varicocele of the cord, and during an ultrasound of the prostate in patients with a benign adenoma or cancer of this gland, a hypoechoic formation of the prostate gland is visualized.

Hypoechoic formation in the subclavian region

A hypoechoic formation in the subclavian region detected during ultrasound may be a sign of:

benign neoplasms and malignant lymphomas of the anterior mediastinum;
chronic lymphocytic leukemia;
lesions of peripheral lymph nodes by metastases of cancer of the thyroid gland, larynx, esophagus, mammary jelly, lungs;
osteosarcomas of thoracic localization;
cysts and echinococcosis of the lungs;
thymoma or carcinoma of the thymus gland.

Hypoechogenicity of structures in this area is noted by clinicians in patients with hyperplasia or cyst of the parathyroid glands, hyperparathyroidism or nodular adenomatosis.

Types of hypoechoic formations

In addition to the anatomical and topographical characteristics of the resulting formation, ultrasonography reveals its shape (round, oval, irregular), width size (cranio-caudal) and depth relative to the outer wall of the organ or cavity.

According to this parameter, the main types of hypoechoic formation include:

a round hypoechoic formation or a hypoechoic oval formation (these are various cysts, varicoceles, adenomas, adrenal tumors of metastatic etiology);
hypoechoic nodular formation (typical of hemangiomas, nodular biliary hypertrophy, uterine fibroids, nodular adenomatosis, etc.);
hypoechoic focal formation (characteristic of cirrhosis and focal fatty infiltration of the liver, hematomas and infarction of the spleen, etc.).

At the conclusion of the ultrasound, the following features of the image contours are noted:

hypoechoic formation with smooth contours (cysts, nodular hypertrophy of the liver, breast tumors);
hypoechoic formation with uneven contours (many tumors, most metastases);
hypoechoic formation with a clear contour (cysts, adenomas, abscesses that have a hyperechoic rim on the ultrasound image);
hypoechoic formation with unclear contours (cavernous hemangions of the liver, thyroid cancer, metastases in organ tissue of any location).

hypoechoic homogeneous formation (carcinoma);
hypoechoic heterogeneous formation (large adenomas, liver cancer, diffuse forms of carcinomas, etc.);
hypoechoic formation with hyperechoic inclusions (renal cell carcinoma, ovarian adenoma, prostate cancer).

A description of the condition of the surrounding tissues, distal acoustic effects (amplification, attenuation, acoustic shadow) and the characteristics of lateral shadows (symmetry, asymmetry, absence) is mandatory.

In addition, the presence/absence of vascularization (that is, blood vessels) in nodular formations is noted, with the definition of such types as: hypoechoic formation without blood flow (avascular) and hypoechoic formation with blood flow.

Formations that have blood vessels are divided into:

hypoechoic formation with perinodular blood flow (subtype with perinodular, i.e. vascularization surrounding the node);
hypoechoic formation with combined blood flow (vessels are present near the formation and inside it);
hypoechoic formation with intranodular blood flow (the presence of vascularization was recorded only inside the formation).

As clinical practice shows, a hypoechoic formation with intranodular blood flow may indicate its malignant nature.

And finally, the presence of calcium compounds in the formation structure is taken into account. And a hypoechoic formation with calcifications (calcinosis) is characteristic of encapsulated chronic liver abscess with amebiasis, liver cancer, neoplasms in the thyroid and prostate glands, malignant tumors of the mammary gland, etc.

Hypoechoic formation in the head of the pancreas

The head of the pancreas is characterized by a unique structure and special shape. It appears as one of the three segments of this organ. Following it is the body, which is separated from the head through a groove - the neck. The gland ends in a tail, which is slightly curved upward.

The head is localized at the level of the first two lumbar vertebrae (in adults). In children who have just been born, it is located a little higher and has a small size. In adulthood, the normal size of the head is up to 35 millimeters.

The uncinate process of the pancreas protrudes as part of the head and is located behind the mesenteric blood vessels. This part of the organ is extremely difficult to examine and mobilize against the background of pancreaticoduodenectomy.

If the functionality of the pancreas is impaired, acute or chronic pancreatitis develops. These diseases lead to complications - necrosis of organ tissue, abscess, etc.

Anatomy of the pancreas

The size of the pancreas varies from 12 to 14 centimeters in length, thickness about 2-3 cm, and width up to 9 centimeters. Normal weight is . The endocrine part is approximately 1-2% of the total mass of the gland.

The internal organ is localized in the peritoneum behind the stomach, located next to the umbilical ring in the area of the left hypochondrium. At the back there is a portal vein, a diaphragm, and below there are mesenteric blood vessels entering the small intestine.

Lymphoid nodes and blood vessels of the spleen are located along the upper edge of the pancreas. Around the head is the duodenum.

The head resembles a small hook, which is localized at the level of the first to third lumbar vertebrae. It is in contact with the small intestine, behind the portal vein, and in front is the transverse colon.
The body of the organ is characterized by a triangular shape. In other words, if visualized on ultrasound, it looks like a triangle with 3 surfaces. On the anterior surface there is an omental tubercle, behind the aorta and mesenteric region.
The tail of the pancreas has a flattened shape and is located at the level of the thoracic vertebra. Ascends to the spleen, behind the right adrenal gland.

The entire organ is covered with connective tissue consisting of lobules. The islets of Langerhans are located in the loose part. Their function is to produce hormones - insulin and glucagon, which regulate the concentration of sugar in the blood.

The excretory ducts form the pancreatic duct, which begins in the middle of the tail and flows into the duodenum.

Pancreatic diseases

Hypoechoic formation in the pancreas is a diagnostic criterion for certain diseases - cysts, hemorrhagic form of pancreatitis, cystadenoma - the disease is prone to malignant degeneration, metastases from tumors of a malignant nature in other organs.

If the tail of the pancreas hurts, this may indicate the development of acute or chronic pancreatitis. This disease, in accordance with the ICD 10 revision code, is assigned the numbers K86.0 and K86.1, respectively.

The causes of acute pancreatitis are due to increased secretion of enzymes by the gland and obstruction of the ampulla of the duodenal papilla. Pancreatic juice is produced, but there is a disorder in its outflow into the duodenum.

Ultrasound examination shows an increase in the parenchyma of the internal organ, which puts pressure on the capsule. Since the organ is well supplied with blood, inflammation rapidly develops.

Patients complain of severe pain. They need immediate assistance from medical specialists. Ignoring symptoms significantly increases the likelihood of complications - necrosis and peritonitis.

If there is no adequate treatment of the pancreas in the acute phase, then a chronic inflammatory process occurs. It comes in the following forms:

Primary type. An independent disease, inflammation is caused by alcohol, poor diet, and metabolic disorders.
The secondary type develops due to diseases of other digestive organs - cholelithiasis, inflammation of the gallbladder (cholecystitis).
Post-traumatic type is a consequence of endoscopic examination or various injuries.

The chronic form is accompanied by insufficiency of the gland, due to which it cannot produce enzymes in the required volume. Ultrasound of the organ shows diffuse disturbances in the structure, sclerosis of the ducts, and the formation of stones.

The consequences of a sluggish inflammatory process are cysts and tumors. Tumors can be hormonally active or hormonally passive.

They are difficult to diagnose and are often discovered when diabetes is diagnosed. Tumors can only be treated surgically.

Treatment of the head and tail of the gland

Capitate pancreatitis is a type of chronic form of the disease. Its name is due to the enlargement of the head of the internal organ of the digestive system. The main symptoms include severe pain. Patients often develop complications - rapidly progressing obstructive jaundice.

The diagnosis is made based on the results obtained through CT, MRI and ultrasound. They show the heterogeneous structure of the organ, the size of the head is more than four centimeters. Sometimes cysts form outside the parenchyma.

Treatment of the head of the pancreas requires surgery. Medicines will not help cure the patient. The method of surgical therapy is median laparotomy, which involves immobilization of the head according to Kocher. The disadvantages of pancreatic surgery include a high degree of trauma and technical complexity.

Against the background of inflammatory processes, the gland increases unevenly. Most often, inflammation of the tail occurs - it thickens and expands, which leads to obstruction of the splenic vein and a portal form of renal hypertension.

Tail enlargement has reasons:

A stone that blocks the duct.
Cystic form of adenoma.
Suppuration of the head.
Pseudocysts.
Tumor of the small intestinal papilla.
Pancreatic cyst.
Pancreas cancer.

Most often, tail enlargement occurs due to tumor growths. At an early stage, it is difficult to suspect a pathological process. Usually the tumor is detected when it reaches an impressive size. The only treatment is surgery. But it has its own difficulties, since in order to get to the tail of the organ you need to go through the spleen or left kidney.

During surgery, the affected tail is removed and the blood vessels are stopped. If damage to nearby organs is observed, they are completely or partially excised. The removed parts during the operation are sent for histological examination. Further drug treatment depends on its results.

An expert will talk about the structure and functions of the pancreas in the video in this article.

Difficulties in diagnosis with reduced echogenicity of the pancreas

Position of the sensor during ultrasound of the pancreas

When echogenicity becomes reduced

Situations where the echogenicity of the pancreas is reduced during ultrasound examination can be observed in cases of diffuse and/or a number of focal changes. In complex sonography of the gastrointestinal tract, the ability to reflect ultrasound by pancreatic tissues is determined in comparison with the liver and gallbladder structures. The pancreas (PG) is not examined separately to determine this indicator.

A decrease in signal registration on a monitor or sonogram, visually perceived as darkening, is indicated by a decrease in echogenicity.

Diffuse (widespread) changes affect the entire gland. The darkening is visible evenly. In the structure of the pancreas, areas of normal reflected signal may appear that are related to the organ and are not pathological.

Items with increased echo response should be considered violations. The contours of the gland with widespread hypoechogenicity will be either clear or barely distinguishable against the background of surrounding structures.

Hypoechoic pancreas

Focal areas of reduced echogenicity are visible as darkening or almost black formations. The number varies. Their contours are visualized clearly or may be blurry and heterogeneous. The background of the underlying pancreatic tissue is also variable: decreased, normal or increased echo response.

Functional and, especially, anatomical changes in the gland that can reduce the intensity of reflected ultrasound are based on the development of edema or replacement of normal tissue.

Diffuse decrease in echogenicity

Violation of the texture of the entire organ, accompanied by changes in structure and size. Often, with a common process in the pancreas, the structure of its ducts changes. The following signs are recorded during inflammation:

acute pancreatitis - the structure is unclear, the contours are uneven, the dimensions are enlarged, small areas of complete absence of an echo signal can be detected (hemorrhages, necrosis);
chronic pancreatitis (early stage) - the structure is relatively clear, the contours are uneven, the dimensions are normal or slightly larger.

During the development and course of inflammation, edema is considered as the main factor that reduces the echogenicity of glandular tissue. An increase in the content of interstitial fluid leads to a weakening of the reflection of ultrasound.

Focal processes

Multiple small areas of reduced echogenicity may indicate previous acute pancreatitis. They form at the sites of former hemorrhages, where further tissue destruction (necrosis) occurred. The overall reflection of ultrasound by the gland may also be slightly reduced.

A single local attenuation of the echo signal is characteristic of:

acute limited pancreatitis - inflammation in any part of the pancreas (head, body, tail) with an increase in only this segment and a change in echo parameters in it;
chronic focal pancreatitis – heterogeneous echo structure of any part of the gland (“marbling” of the tissue);
neoplasm.

With regard to tumors and tumor-like changes, it is necessary to take into account that sonography is not a completely reliable method of detecting, much less identifying, such processes. But, first, an ultrasound diagnostic specialist can distinguish a benign formation from cancer.

The cyst has clear boundaries, represented by a capsule, and is visualized as a rim with an increased echo signal surrounding the area of complete absence of ultrasound reflection. One of its main characteristics is that it is a formation that has a regular round or oval shape.

A pseudocyst does not have a capsule. The darkened area at the borders, visible on the device monitor and sonograms, gradually transforms into the echo structures of the unchanged gland.

A malignant tumor is characterized as a homogeneous hypoechoic formation, having wavy borders with thin outgrowths along the periphery. There is a change in the contours of the gland itself - protrusions are visible at the tumor site.

Tumor of the head of the pancreas

High-class ultrasound scanning equipment and appropriate qualifications of a specialist make it possible to reduce diagnostic errors in the early detection of tumors. This is facilitated by the presence of a Doppler mode, which evaluates the presence of blood flow in the formation and its intensity.

There are a number of reasons why the echogenicity of the pancreas may be reduced, but this is not related to the above. Visualization deteriorates when the patient is insufficiently or incorrectly prepared for the study or is overweight. In addition, in the case of isolated liver disease, the normal echo signal from the pancreas will be determined to be attenuated in comparison.

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A person’s complaints of severe pain in the left hypochondrium often indicate inflammation of the pancreas. The examination of the patient begins with an ultrasound of the abdominal organs. A diagnostic method based on measuring the intensity of reflection of sound waves from the surface of organ tissues makes it possible to identify the smallest deviations in the functioning of the digestive system.

When assessing an echogram and morphological parameters of tissues, it is difficult for a doctor to make a mistake. The images that the sonographer creates during the examination are different in color. Light colors indicate the presence of seals in the organ, dark and black colors indicate liquid formations. A healthy pancreas, due to its homogeneous watery structure, is displayed in dark colors. The opposite picture indicates pathological changes and organ disease.

If you have been diagnosed with increased echogenicity of the pancreas, then carefully study the information below.

What is echogenicity

Echogenicity is a sign system used by uzologists, which allows one to establish the correspondence of the anatomy of organs to the level of reflection and absorption of high-frequency waves. Liquid tissue of the pancreas is characterized by an average echogenicity. The echo density of the liver parenchyma is used as a standard sample.

Echogenicity scale for assessing study results

Using ultrasound, you can not only determine the degree to which internal organs perceive high-frequency waves, but also obtain information about other equally important parameters. During the examination of the gland, the following parameters are carefully studied:

Size.
Form.
Structure.
Circuit.

When determining the volume of the pancreas, the length of the head, body and tail is calculated. Ideally, they should not exceed 30, 24 and 25 mm, respectively. An increase in the latter indicates local or general inflammation in the organ. Abnormally large sizes are a typical sign of pancreatitis. Causes of increased size can also be: abdominal trauma, cystic fibrosis, biliary dyskinesia, hepatitis, infectious diseases. Local changes are associated with malignant tumors and cysts.

In appearance, the digestive gland resembles a comma and has an oblong shape. Sometimes there is a thickening in the head area. Ring-shaped, additional, split forms are deviations from the norm. Improper development of the organs of the digestive system is associated with disturbances in the processes of embryogenesis.

Healthy pancreas. The dark longitudinal stripe is the hypoechoic shadow of the duct.

As for the external contours, they must be clearly defined in the longitudinal and cross sections. Blurring of any part of the gland may indicate the development of an inflammatory process. Blurred outlines and swelling also cause diseases of the organs adjacent to the pancreas (stomach and duodenal ulcers). Uneven borders are created by tumors, cysts, and stones. The contours of malignant formations are lumpy and blurry.

The structure of the digestive gland should be homogeneous and fine-grained. Having discovered single fatty inclusions or numerous calcifications and pseudocysts in the organ, the doctor has every reason to suspect fibrolipomatosis and chronic pancreatitis in the patient.

Insufficient preparation of the person himself can lead to errors in research results. Three days before the procedure, the patient must adhere to a diet that eliminates the possibility of increased gas formation. For prevention, patients are recommended to take adsorbents. On the day of the procedure, it is advisable to empty your bowels and limit your food intake.

What does increased echogenicity mean?

An unusual increase in the recoil force of the waves indicates compaction of the parenchyma and a reduction in the amount of fluid in it. Diffuse hyperechogenicity, the causes of which are external factors, is not considered a pathology. Most often it manifests itself in the hot season, after eating hot and rich food, and during colds.

Echogenicity increases markedly with inflammation. Causes for concern may be: tumors, metastases, calcium deposits and stones, cysts, fibrosis. Such inclusions are the consequences of ignoring the early symptoms of pancreatitis.

A number of parameters indicate acute pancreatitis:

General increase in organ size.
Presence of large echogenic areas.
Heterogeneity of structure.
Exceeding the width of the gland duct.
Blurred boundaries.

A more severe form of the disease involves changes in the density and contours of neighboring organs. Possible formation of pseudocysts.

When diagnosing chronic pancreatitis, the following picture is observed:

Echogenicity increases slightly.
The width of the duct increases by more than 2 mm.
The size of the gland itself increases.
Unclear outline.
Heterogeneous structure.
There is fluid in the omental bursa behind the stomach.

The disease may be accompanied by the formation of stones. In the picture they appear as spots with an echogenic trace. The progressive disease is easy to notice due to the significant discrepancy in the ratio of the size of the gland to the Wirsung duct. The latter is greatly swollen in width.

Parameters such as increased echogenicity and blurred contours suggest that healthy cells in the organ have replaced fat cells, which occurs with lipomatosis. Hyperechogenicity along with a decrease in the pancreas indicate the development of fibrosis. The growth of connective tissue and its replacement of normal cells is accompanied by the appearance of scars.

Ultrasound alone is not enough to accurately diagnose a patient. The patient is sent for auxiliary procedures: magnetic resonance or computed tomography, laparoscopy or biopsy.

A lighter image of the pancreas indicates increased echogenicity

Heterogeneity of structure

In a healthy person, pancreatic tissue is homogeneous, fine-grained, and homogeneous. The echostructure suspiciously increases in subacute and chronic pancreatitis, cysts and tumors.

Acute interstitial pancreatitis is often diagnosed in people who abuse alcoholic beverages and high-fat foods. On palpation they feel sharp pain. Unpleasant symptoms are associated with swelling of the gland. A person complains of cramps in the upper abdomen may contact a doctor.

The heterogeneity of the structure is indicated by arrows (white and dark areas).

Severe pain in the left or right hypochondrium occurs with chronic pancreatitis. During periods of exacerbation of the disease, the patient experiences an increase in temperature, abnormal blood pressure, changes in the color of the skin and sclera (jaundice). The patient is worried about constant nausea, vomiting, and lack of appetite. In addition to poor nutrition, the following diseases can affect the development of pancreatitis:

There are many lovers of alcoholic beverages among men, so the likelihood of chronic pancreatitis in the stronger half of humanity is much higher than in women.

Heterogeneity of structure in children

Changes in the homogeneity of the structure of the pancreas often occur in childhood. They manifest themselves as disruptions in the functioning of the gastrointestinal tract. Disturbances occur due to spasms of the gland ducts and increased enzyme activity. The obstructed outflow of the latter causes swelling of the pancreas in the child.

This form of the disease occurs even in children 1 year of age. Parents who do not follow the schedule for introducing complementary foods (early inclusion of meat and fish dishes in the menu) can be blamed for this.

Why deviations are dangerous

Negligence towards pancreatitis can increase the risk of new foci of inflammation. The combination of diseases affects the overall health of a person. A critical manifestation of complications is disability.

If treatment of the disease is not started at its early stage, pancreatic enzymes enter the blood and create conditions for infection of other organs. Several diseases find a corresponding response:

Liver and kidney failure.
Bleeding in the stomach and intestines, erosions, ulcers.
DIC syndrome (blood clotting disorder).
Purulent-necrotic parapancreatitis.
Mechanical jaundice.
Liver hepatosis.
Cholangitis, cholecystitis.
Abdominal abscess.

Necrosis of the gland parenchyma develops tumors and cysts. Malignant tumors often appear in older men. Unusual thinness, loss of appetite, abdominal pain are the main symptoms of the disease. Only adequate timely therapy can reduce the chances of such complications occurring.

How to treat

A gastroenterologist can give a specific definition of the term “increased echogenicity.” To begin with, he will make sure that the ultrasound data is accurate and will exclude the manifestation of a diffusely heterogeneous structure of the gland.

Treatment is prescribed after determining the cause of hyperechogenicity. Additional tests and studies will help clarify it. After a short period of time, the person undergoes a repeat ultrasound.

If any form of pancreatitis is confirmed, the patient is recommended to be hospitalized. Depending on the severity of the disease, he may be prescribed: antispasmodics, antisecretory drugs, pancreatic enzymes, vitamin complexes. It is strictly necessary for the patient to follow a proper diet. Even very small portions of fried, smoked and fatty foods can increase the picture of unpleasant symptoms. Alcohol is absolutely prohibited for patients.

Severe forms of pancreatitis are treated surgically using laparoscopy. People with poor health are recommended to visit sanatoriums that specialize in gastrointestinal diseases.

If the increase in echogenicity is associated with the presence of tumors in the body, the patient may be referred for chemotherapy and radiotherapy. Treatment is selected according to the type of endocrine formation.

Whatever the nature of the echogenicity, if you have the slightest doubt about the ultrasound results, you should seek advice from an experienced doctor. Timing is especially important in this matter. Treatment is more likely to lead to a favorable outcome if it is done early. Often, to reduce the inflammatory process, it is enough to use only medications.

Source: projivot.ru

What is echogenicity called and how is it detected on ultrasound?

On the monitor screen of an ultrasound machine, this indicator is visualized in the form of a gray scale, which, depending on the state of performance of the organ under study, changes its shade level.

It is important to remember that the norm of the pancreas echogenicity indicator corresponds to the level of this indicator of a healthy liver. Any decrease or increase in echogenicity is also always compared with liver parameters.

Causes of pathological changes in the level of echogenicity

The development of the following pathological processes can reduce or increase the level of the ability of the pancreas to reflect ultrasound:

the formation of calcifications, or as they are also called small pebbles in the pancreas;
development of pancreatic pathology (inflammatory process) of an acute or chronic nature;
development of tumor-like neoplasms;
the progressive stage of lipomatosis, that is, the replacement of healthy glandular tissues with fatty tissues;
necrotic lesion of the parenchyma.

The development of each of the above pathological processes is clearly visible on the monitor screen of the diagnostic apparatus.

Types of hypoechoic formations

The progressive stage of acute pancreatitis contributes to a significant increase in the size of the parenchymal organ, and also acts as an acute factor that reduces echogenicity.

In some cases, echogenicity may be reduced to such an extent that the pancreas is almost impossible to distinguish from the splenic and portal veins.

The formation of focal hypoechogenicity may be preceded by the following pathological changes:

cystic lesion of the parenchyma;
development of a pancreatic cyst;
the appearance of a tumor-like neoplasm;
an increase in the diameter of the ducts of the gland being studied.

It is important to remember that the focal type of the gland’s ability to reflect ultrasound can be not only reduced, but also increased, depending on what type of tumor-like neoplasm occurs.

Treatment methods

Therapeutic methods of treatment for any type of pathological deviation of the echo structure of the gland from the norm are developed taking into account the results of additional diagnostic methods, such as laboratory testing of feces, urine and blood, as well as based on the diagnosis.
Most often, medications are prescribed, which are based on synthetic or natural enzymes that help reduce the overall level of load on the affected organ, or, for a certain period of time, perform its functions in the absorption of nutritional components from food taken.

Antispasmodic drugs will help reduce pain and eliminate the feeling of unpleasant discomfort.

As a complement to the main treatment, a strict dietary diet is prescribed. Exceptions should be made to the following ingredients:

alcohol-containing and carbonated drinks;
fatty foods;
semi-smoked and smoked food products;
fried and heavy foods.

Bibliography

Sidu P.S., Chong W.K. Ultrasound measurements. Practical guide. Medical Literature Moscow, 2012
Maev, I.V. Ultrasound diagnosis of diseases of the digestive system. Tutorial. Ministry of Health and Social Development of the Russian Federation. M. Federal State Educational Institution VUNMC Roszdrav, 2005
Drobakha I.V., Yakusheva L.V., Malysheva T.F., Chavgun L.B. Ultrasound in the diagnosis of acute pancreatitis. Congress of the Association of Ultrasound Diagnostics in Medicine, abstracts. M., 1995, p. 82.
Lemeshko, Z. A. Ultrasound diagnosis of gastric diseases. M. GEOTAR-Media, 2009
Fedoruk, A.M. Ultrasonography in the diagnosis and treatment of acute pancreatitis. Minsk, 2005

Click on pictures to enlarge.

Pancreatic cysts on ultrasound

Photo. Simple pancreatic cysts on ultrasound. A, B — Single simple cysts in the area of the body (A) and neck (B) of the pancreas with a thin smooth wall and anechoic contents. B - Classic signs of chronic pancreatitis: the main pancreatic duct is dilated against the background of parenchymal atrophy, the contour of the gland is uneven with notches, there is calcification and small cysts in the parenchyma.

Important!!! Simple pancreatic cysts are common, but don't forget about cystic tumors. Cancer is the most dangerous disease of the pancreas.

Photo. A, B - Benign microcystic adenoma of the pancreas: a large cystic formation in the head of the pancreas. B - Pancreatic adenoma with macro- and microcystic components.

As a result of pronounced dilation of the pancreatic duct, retention pseudocysts may form distal to the site of obstruction.

Acute pancreatitis on ultrasound

Acute pancreatitis is a severe complication of gallstone disease or a consequence of toxic effects, such as alcohol.

Photo. Acute pancreatitis on ultrasound: A - Swelling of the pancreatic parenchyma (p), the contour of the pancreas is unusually clear, a small accumulation of fluid along the border (arrows). B, C - Accumulation of fluid along the contour of the body of the pancreas, a thin rim of fluid along the splenic vein (arrows), the parenchyma is heterogeneous, the surrounding tissue is hyperechoic - swelling and inflammation, the common bile duct is dilated (B). In this case, gallstone disease must be excluded.

Photo. Acute pancreatitis on ultrasound: The pancreas is unusually contrasted against the background of hyperechoic surrounding tissues, a thin strip of fluid along the contour (A), a hypoechoic focus in the tail (B), fluid in the hilum of the spleen (C). A hypoechoic tail can be mistaken for a tumor.

In severe cases of pancreatitis, pancreatic fluid digests surrounding tissue, forming pseudocysts. Such cysts can be single or multiple. They may increase in size and rupture.

Photo. A - Large pseudocyst between the head of the pancreas and the liver after pancreatitis. B, C - Severe necrotizing pancreatitis longitudinal (B) and transverse (C) sections: extensive necrosis, melting of the surrounding fat in the tail area, accumulation of fluid around the gland.

Chronic pancreatitis on ultrasound

Calcifications in the pancreas on ultrasound

Important!!! If there is dilatation of the pancreatic duct, you should look for stones in the pancreatic duct and in the common bile duct.

Photo. A - There is a small stone in the dilated duct. B - In the dilated pancreatic duct there is a row of several stones with shadowing behind. B — A patient with chronic pancreatitis has huge stones in the dilated duct. Note the intense shading behind.

Photo. A, B — Calcifications in the pancreatic parenchyma in patients with chronic pancreatitis. Some calcifications have a shadow. B — A 5-year-old boy with chronic hereditary pancreatitis: calcifications (small arrows) and dilatation of the pancreatic duct (large arrow). C - confluence of the superior mesenteric and splenic veins.

Dilated pancreatic duct on ultrasound

Photo. A man with insulin-dependent diabetes mellitus complains of weight loss and abdominal pain for several months. Ultrasound shows an enlarged common pancreatic duct with an uneven wall. Upon further examination, calcifications with a shadow behind them are clearly visible in the duct (B).

Photo. A patient with acute pancreatitis: a large pseudocyst has formed at the level of the tail (see above), the dilated pancreatic duct opens into a pseudocyst.

Pancreatic tumors on ultrasound

Photo. Carcinoma of the head of the pancreas (arrow): the common bile duct (A) and pancreatic duct (B) are dilated, and a hypoechoic tumor surrounds the superior mesenteric vein (C).

With tumors of the head of the pancreas, the common bile and pancreatic duct is often dilated, unlike chronic pancreatitis, its walls are smooth and not compacted.

Important!!! Visualization of the main pancreatic duct within the hypoechoic zone is in favor of local edema and against tumor.

Photo. Carcinoma of the head of the pancreas: the contour of the head is uneven due to a volumetric hypoechoic formation, the parenchyma of the body is very thin (atrophy), the pancreatic (A) and common bile (B) ducts are dilated, and there is a large round lymph node (C) at the porta hepatis.

Photo. A large lymph node (arrow) next to the pancreas may be mistaken for a tumor of the head. Enlarged mesenteric lymph nodes are round in shape, hypoechoic and without a central scar, which indicates their malignancy.

Photo. Large neuroendocrine tumor(arrows) of the pancreas with calcification and liver metastases (B).

Take care of yourself, Your Diagnosticer!