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The pancreas

image of The pancreas
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Abstract

The pancreas is composed of a body and two lobes or limbs; the body separates the right and left lobes and is located just ventral to the portal vein, between the pylorus and the proximal descending duodenum. The right lobe runs in a caudal direction in the mesoduodenum, near or in contact with the body wall, just ventral to the right kidney. The left pancreatic lobe is located caudal to the greater curvature of the stomach, cranial to the transverse colon, and extends laterally to terminate close to the cranial pole of the left kidney. In the cat the left lobe may extend dorsally, caudal to the spleen. The pancreas is vasularized by branches of the cranial and caudal pancreaticoduodenal arteries, and by the pancreatic branch of the splenic artery. Venous drainage of the right lobe is mostly through the caudal pancreaticoduodenal vein, the last tributary od the classic mesenteric vein. The left lobe drains into the splenic vein. There are two excretory ducts: the accessory pancreatic duct, which terminates in the duodenum at the minor duodenal papilla; and the pancreatic duct, which terminates at the major duodenal papilla together with the common bile duct. This chapter considers Overview of anatomy; Radiographic detection of pancreatic disease; Ultrasonography; Overview of additional imaging modalities; and Pancreatic diseases.

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Figures

Image of 13.1
13.1 Ventral view of the pancreas and its associated anatomical landmarks. The right lobe of the pancreas (RL) runs along the medial margin of the descending duodenum (Duo). The pancreatic body (B) connects the right to the left lobe (LL), which is located caudal to the greater curvature of the stomach. The accessory pancreatic duct (APd) is the primary excretory duct in dogs and terminates at the minor duodenal papilla. The pancreatic duct (Pd) is the main excretory duct in cats and terminates at the major duodenal papilla together with the common bile duct (Bd). Gb = Gallbladder; LK = Left kidney; RK = Right kidney; S = Spleen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
Image of 13.2
13.2 Digital VD radiograph of a 14-year-old male neutered Oriental Shorthaired cat presented for annual evaluation of chronic renal disease. The soft tissue opacity caudal to the spleen and cranial to the left kidney (arrowheads) represents the left lobe of the pancreas. Note the bilaterally small kidneys.
Image of 13.3
13.3 Lateral and VD digital radiographs of a 7-year-old Labrador Retriever evaluated for rapid weight loss and anorexia. There is a large mass effect in the right cranial abdominal quadrant (white asterisk) with loss of serosal detail. On the lateral view, the gastric fundus is displaced cranially (black arrowhead), the colon and small intestines are displaced caudoventrally (white arrowhead) and the kidneys are displaced caudally (black asterisk). The final diagnosis was metastatic pancreatic adenocarcinoma.
Image of 13.4
13.4 Right lobe of the pancreas (between calipers) in an 8-year-old male Labrador Retriever with ascites; the duodenum (D) is in transverse section. Note the hyperechoic appearance of the pancreas caused by distal enhancement from the surrounding fluid.
Image of 13.5
13.5 Normal right lobe of the pancreas in a 13-year-old spayed Dachshund bitch. The duodenum (D) and pancreas (between asterisks) are in transverse section. The normal duodenum appears as a target-like structure and the pancreas shows medium echogenicity. The anechoic circular structure in the centre of the pancreas is the pancreaticoduodenal vein and can be distinguished from the pancreatic duct with the use of colour Doppler ultrasonography. (Courtesy of S Hecht)
Image of 13.6
13.6 Normal body and left lobe of the pancreas in a 15-year-old male neutered Domestic Shorthaired cat. Doppler signal is visible in the splenic vein and the left pancreatic lobe is the structure of medium echogenicity seen ventral to it (between the asterisks). The normal pancreatic duct is visible in the centre of the pancreas and shows no Doppler signal. (Courtesy of S Hecht)
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13.7 Post-contrast ultrasonogram of the pancreas (arrowheads) in a normal dog. Note the uniform hyperechoic appearance of the pancreas, indicative of uniform enhancement. (Courtesy of R O’Brien)
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13.8 Post-contrast ultrasonogram of the pancreas (arrowheads) in a dog with severe pancreatitis. Note the heterogenous appearance of the pancreas with hypoechoic areas consistent with perfusion defects. (Courtesy of R O’Brien)
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13.9 Post-contrast axial CT scan of the pancreas of an adult Golden Retriever, obtained at 10 mm slice thickness and 10 mm increments. The image is displayed in a soft tissue window (width 300 HU, level 30 HU). Diluted positive contrast medium (barium) was administered orally prior to the study and is seen in the stomach (S). Note the enlarged pancreas (arrowhead) and the surrounding striated, hyperattenuating mesentery, consistent with peritonitis. The final diagnosis was severe pancreatitis. d = Duodenum.
Image of 13.10
13.10 Post-contrast helical CT scan of the pancreas of a 13-year-old male neutered Weimaraner, obtained at 3 mm slice thickness, evaluated for tremor, ataxia and profound hypoglycaemia. The image is displayed in a soft tissue window (width 350 HU, level 50 HU). A focal mass (asterisk) is seen in the central abdomen; the mass has similar density and enhancement pattern to the body of the pancreas (arrowhead). At surgery, the mass was identified as a metastatic pancreatic lymph node and a small islet cell carcinoma was identified adjacent to it. Ao = Aorta; C = Caudal vena cava; P = Portal vein; S = Spleen.
Image of 13.11
13.11 Lateral and VD digital radiographs of a 12-year-old male mixed breed dog evaluated for pancreatitis. Note the loss of detail in the mid-abdomen, caudal to the stomach (asterisk), and the lateral displacement of the fluid-filled duodenum (between arrowheads in b) with widening of the gastroduodenal angle.
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13.12 Lateral and VD conventional radiographs of a 5-year-old male Cocker Spaniel with severe pancreatitis. The duodenum (between arrowheads) is distended with gas and displaced laterally along the right abdominal wall. Note also the loss of serosal detail and the mass effect in the right cranial abdomen.
Image of 13.13
13.13 Mild pancreatitis in a 12-year-old male mixed breed dog. Note the hypoechoic right pancreatic lobe (between asterisks).
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13.14 Acute pancreatitis in a 6-year-old spayed Yorkshire Terrier bitch. Transverse section of the left lobe of the pancreas (between calipers) and duodenum (D). Note the enlarged hypoechoic pancreas with surrounding hyperechoic mesentery. Oblique to longitudinal plane image. The hypoechoic, irregular, enlarged left lobe of the pancreas (asterisk) is seen dorsal to the descending duodenum (D). Note the hyperechoic mesentery surrounding the pancreas.
Image of 13.15
13.15 Acute pancreatitis in a 14-year-old male neutered Toy Poodle. An irregularly shaped anechoic pocket of fluid (arrowheads) is visible, together with a hyperechoic mesentery. These findings are consistent with peritonitis.
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13.16 Acute pancreatitis in a 6-year-old spayed Yorkshire Terrier bitch (same dog as in Figure 13.14 ). The longitudinal image of the descending duodenum shows corrugation, which did not change over time, and thickening of the duodenal wall (6.2 mm between calipers). These findings are consistent with duodenitis.
Image of 13.17
13.17 Forming pancreatic pseudocyst in a middle-aged male neutered Poodle. This image was obtained in a parasagittal plane, caudal to the stomach (S); the ventral aspect of the liver (L), which was mildly enlarged, is also visible in the near-field. The anechoic irregularly shaped area caudal to the stomach and liver (between arrowheads), with surrounding hyperechoic mesentery and mild distal acoustic enhancement, was an organizing collection of fluid and necrotic tissue that developed into a pseudocyst.
Image of 13.18
13.18 Pancreatic abscess in a 9-year-old male neutered Labrador Retriever with a 1-month history of severe pancreatitis. The abscess is a well defined, anechoic cyst-like structure with strong distal enhancement. Ultrasound-guided drainage was performed successfully. Pancreatic abscess of the right lobe in an 8-year-old spayed Miniature Schnauzer bitch. The duodenum (D) is in transverse section. The abscess (between asterisks) is a well defined mass of mixed echogenicity, with a thick echogenic wall and anechoic centre, containing numerous hyperechoic speckles in the distal aspect. Surgical exploration confirmed the diagnosis.
Image of 13.19
13.19 Lateral and VD conventional radiographs of a 7-year-old male Yorkshire Terrier with weight loss, inappetence and abdominal distension. There is a very large craniodorsal abdominal mass, originating from the left cranial quadrant. There is displacement of the colon and small intestines caudally, ventrally and towards the right (arrowheads). The spleen (S) and kidneys (K) are visible. The stomach (asterisks) is visible on the lateral view. The final diagnosis was carcinoma. The same dog as in Figure 13.3 . A large (3.2 cm x 2.7 cm) mass with irregular margins and mixed echogenicity is seen arising from the body of the pancreas. The final diagnosis was metastatic pancreatic adenocarcinoma.
Image of 13.20
13.20 Rounded, hypoechoic mildly enlarged (7 mm between calipers) pancreatic lymph node. This patient had severe chronic pancreatitis and diabetic ketoacidosis. D = Duodenum; si = Small intestine.

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