Hypoechoic heterogeneous pancreatic mass. Pathology of the pancreas on ultrasound (lecture on Diagnostic)

On ultrasound, each organ has its own echogenicity, or degree of density. The fluid is always anechoic (“black on screen”) and the bones are hyperechoic, or bright white. The echogenicity of the pancreas is usually compared with that of a healthy liver, since in most cases they are the same. In addition, a healthy pancreas on ultrasound may be heterogeneous and fine-grained, increased echogenicity, and in young children breastfeeding have reduced echogenicity.

Probe position for pancreatic ultrasound

When echogenicity becomes reduced

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

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

Diffuse (common) changes affect the entire gland. Darkening is viewed evenly. In the structure of the pancreas, areas of the normal reflected signal that are related to the organ and are not pathological can appear.

Elements with enhanced echo response should be treated as 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 seen as blackouts or almost black formations. The number varies. Their contours are visualized clearly or can be blurred and inhomogeneous. The background of the underlying pancreatic tissue is also variable: reduced, normal, or enhanced 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 tissues.

Diffuse attenuation of echogenicity

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

• acute pancreatitis - the structure is fuzzy, the contours are uneven, the dimensions are enlarged, small areas can be determined total absence echo signal (hemorrhage, 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 the 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 a previous acute pancreatitis. They are formed at the sites of former hemorrhages, where further tissue destruction (necrosis) occurred. The total reflection of ultrasound by the gland can also be somewhat 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 - a heterogeneous echo structure of any department of the gland ("marbling" of the tissue);
• neoplasm.

With regard to tumors and tumor-like changes, it must be taken into account that sonography is not a completely reliable method for detecting, let alone identifying, such processes. But, beforehand, a specialist in ultrasound diagnostics can distinguish a benign formation from cancer.

The cyst has clear boundaries, represented by a capsule, which 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 such a formation that has a regular round or oval shape.

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

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

Tumor of the head of the pancreas

The high class of ultrasound scanning equipment and the corresponding qualification of a specialist can reduce diagnostic errors at early detection tumors. This is facilitated by the presence of the Doppler mode, which assesses 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. Imaging worsens with insufficient or incorrect preparation of the patient for the study, the presence of excess weight. In addition, in the case of an isolated liver disease, the normal echo from the pancreas will be defined as attenuated by comparison with it.

Instrumental diagnostics by ultrasonic scanning (ultrasound), which is also called ultrasonography, can detect areas with different acoustic density in internal organs and cavities - hyperechoic or hypoechoic formation.

What does hypoechoic mass mean?

A local hypoechoic formation in a particular organ, in contrast to a hyperechoic one, is the result of a 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 of 2-5, 5-10 or 10-15 MHz). And this is evidence that this formation - in terms of its structure - either contains a liquid or has a cavity.

A hypoechoic formation on the screen is visualized in the form of gray, dark gray and almost black zones (with hyperechogenicity, the zones are light, often white). To decipher the ultrasound image, there is a scale of six gray scale categories Gray Scale Imaging, where each pixel of the image of a hypoechoic formation obtained on the monitor depends on the strength ultrasonic signal returned to the sensors is 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.), compared with the indicators of tests submitted by patients and the results of other studies.

In many cases it is required differential diagnosis, for which, in addition to ultrasound, other hardware methods of visualizing the pathology (angiography, color Doppler, CT, MRI, etc.) are used, as well as a histological examination of biopsy specimens.

Causes of hypoechoic formation

As an indicator of ultrasonography, a hypoechoic mass can have any localization. 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 mass in the pancreas is considered diagnostic criterion detection of such pathologies as cysts, hemorrhagic pancreatitis, mucinous cystoadenoma (which is prone to malignancy), adenocarcinoma of the pancreatic head, metastases in malignant tumors of other organs.

Hypoechoic mass in the liver and gallbladder

Healthy hepatic tissues are moderately hyperechoic, and hypoechoic formation in the liver may occur with cirrhotic lesions; focal steatosis; cysts (including those with Echinococcus multilocularis); biliary abscess; hepatocellular adenoma; focal parenchymal hyperplasia; small hepatoma and cholangiocellular adenocarcinoma.

Hypoechoic formations are also visualized in cases of spread of diffuse metastases of cancer of the pancreas, ovaries, mammary glands, testicle, gastrointestinal tract to the liver.

In ultrasound diagnostics of pathologies of the gallbladder, 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, one should name polyps, adenocarcinoma (with an intact outer layer of the bladder), lymphomas (tumors of lymph nodes), angiosarcoma.

Hypoechoic masses of the spleen

Normally, the echogenicity of the spleen is homogeneous, although slightly higher than that of the liver. But due to the high vascularity, ultrasound of the spleen is performed with a contrast agent that 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.

These formations include:

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

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

Hypoechoic mass in the kidney, adrenal glands and bladder

Hypoechoic formation in the kidney can be detected with inclusions in the parenchyma of cystic formations (including low-quality ones), hematomas (at the initial stages), pyogenic perirenal 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, unfortunately, ultrasound does not always cope with it. For example, verification of the diagnosis of adenoma in primary aldosteronism, as well as pathological proliferation of cells of the adrenal cortex in hypercortisolism (Itsenko-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 expedient to examine the adrenal glands with the help of CT and MRI.

With the development of benign leiomyoma, transitional cell carcinoma Bladder or pheochromocytoma (paraganglioma) of the bladder, which is accompanied by arterial hypertension and hematuria, when examined on ultrasound, a hypoechoic formation in the bladder is visualized.

Hypoechoic mass in the abdomen and pelvis

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

In a far from complete list of reasons that cause a hypoechoic formation in the abdominal cavity visualized by ultrasound, there are:

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

Treatment

Patients can ask the doctor what treatment of hypoechoic formation is necessary, and what medications are prescribed for this ... But they treat not abnormal areas detected by ultrasound, but diseases that have caused a pathological change in tissue density that weakly reflects ultrasonic waves.

Ultrasound examination of the pancreas is carried out in the morning on an empty stomach after special preparation of the patient through skin epigastric region in the position of the patient on the back, on the right side, from the side of the back and standing at the height of inspiration or with protrusion of the abdomen. The research technique from the back is uninformative and is rarely used, although sometimes it is possible to visualize the tail of the pancreas well. In some cases, when the contours of the gland cannot be differentiated, the study is carried out against the background of a stomach filled with water (the patient is invited to drink 4 glasses of warm water, thereby creating an artificial anechoic window through which the gland is clearly visible).

It should be remembered that the water load for a number of patients is limited. For visualization can be used different types sensors (sector, convex, trapezoidal and linear) with a frequency of 2.5 to 5 MHz. For obese patients, sensors are used at 2.5-3.5 MHz, and for children and thin patients - 5 MHz.

Optimal information for full pancreatic imaging can only be obtained with a combination of all types of sensors and scanning methods. Unfortunately, devices with such a complete set are very expensive and inaccessible for ordinary clinics and hospitals. The standard equipment of the device usually includes a linear probe (rarely convex) at 3.5 MHz.

To obtain a good image of the pancreas, it is enough to use the standard classical scanning techniques - longitudinal, transverse and oblique. They complement each other.

On the echogram, a normal pancreas in a longitudinal scan (the probe is in a transverse position) is located in the epigastric region in the form of a comma or a stretched semi-oval around the transverse scan of the abdominal aorta, with smooth contours that are well delimited from the surrounding tissues, with a slightly more increased echogenicity of the structure than bordering with it, the tissue is displaced during the act of breathing. In thin people and in children, the pancreas is located better, since it is located quite close to the anterior abdominal wall.

The study of the pancreas should begin with a survey scan of the epigastric region, and, since sometimes it is found strictly under the left lobe of the liver. The main reference point for echolocation of the pancreas is the splenic vein. The pancreas is divided into head, neck, body and tail.

The head of the gland is located to the right of the spine in the curvature duodenum and is located in the form of an oval formation.

The neck is a short narrowing between the head and the body, which can rarely be differentiated from the body. At the level of the head and neck, they are located behind v. portae, v. cava inferior and the common bile duct. Above and slightly to the right is located gallbladder.

The body is usually located under the left lobe of the liver and is located almost constantly. The reference point for its echolocation is the pulsating abdominal aorta, its transverse scan; its superior mesenteric artery (transverse scan) is located 1-2 cm above and to the left of the aorta (transverse scan) in the form of a small oval. The left hepatic vein is sometimes located between the aorta and the superior mesenteric artery. Under the body and tail, the splenic vein is also constantly located in the form of a longitudinal anechoic path, and above it - the splenic artery.

The tail of the pancreas is located to the left of the spine, bends around the abdominal aorta and goes slightly up and to the left of the lateral part of the gate of the spleen or the upper pole of the left kidney. Sometimes the bottom of the stomach is located above the tail of the pancreas, especially when it is ptotic and when there is liquid in it. The tail of the pancreas is rarely located completely, mostly it is located partially and inconsistently. According to a number of authors, the frequency of detection of a normal pancreas by echography varies from 40 to 100%. It is easier to locate an enlarged, pathologically altered. With experience, in most cases it can be seen in its entirety, however, its detailed study is possible only when examining parts in different scans.

According to our data, a clear visualization of the entire gland is possible in 93% of patients, the head — in 97%, the body — in 100%, and the tail — in 83%. Due to the peculiarities of the anatomical location, it is very difficult to determine the length of the entire gland sonographically. In practice, to determine the length of the gland, we conditionally divided it into two parts. For this purpose, three imaginary lines parallel to the spine were drawn: 1st — the beginning of the outer part of the head, 2nd — in the middle of the transverse scan of the superior mesenteric artery, 3rd — the end of the most distant external visible part of the tail. For addition, you should take the optimal length of each part. Most simple technique- this is a measurement of length from the beginning of the outer part of the head (A) to the maximum protrusion of the body (B) and further to the visible outer part of the tail (C).

Normally, echographically, the length of the pancreas averages 8-11 cm, while on corpses it reaches 18 cm, the anteroposterior head size ranges from 16-22.5 cm, the anteroposterior body size is 8-12.8, and the tail is 16.7-18.9 cm. The area should not exceed 50 cm2.

It should be noted that for a number of objective reasons, the echographic dimensions of the pancreas never correspond to the anatomical ones, however, the obtained parameters in dynamics and in combination with the clinic of any pathological process completely satisfy the clinician. The most reliable criteria for changing the size of the gland is the dynamic determination of its area.

Along with contours and dimensions, the echostructure is given great importance in the decision of a question of norm or pathology. Although in the practice of ultrasound diagnostics it is believed that the normal structure of the pancreas should be close in echogenicity to that of a healthy left lobe of the liver. According to our data, at the present stage of development of ultrasound technology, there are no single clear criteria for the normal echogenicity of the gland structure, since in different age categories there are practically healthy people at absolutely normal parameters, the echogenicity of the structure is different. It seemed that children are an ideal group, where the echogenicity of the gland should be more or less constant and of the same intensity. But even in groups of the same age and weight, the echogenicity of the structure is different. This disproportion is more pronounced in adults, and gender has little effect on echogenicity. In pathomorphological studies of the pancreas on corpses, it turned out that in all cases when the echogenicity of the gland in children was high, the parenchyma between the lobules contained a large amount of fat, and in old age - coarse fat and connective tissue. Of course, further study is required of the causes affecting the heterogeneity of the echogenicity of the structure of the parenchyma of the gland in some children and young adults.

Comparing the data of the echo picture with histological studies, it can be assumed that the intensity of the echogenicity of the structure of the parenchyma of the gland to some extent depends on individual features carbohydrate and fat metabolism in humans and is associated with the fact that in last years in connection with social upheavals in the territories former USSR population began to eat more fats and carbohydrates. It should be noted that the level of intensity of the echogenicity of the structure of the parenchyma of the gland also depends on the resolution (density), the frequency of the sensor and the correct adjustment of the brightness and contrast of the device, which means that there is a lot of subjectivity in the visual assessment.

In our practice, we have identified two types of structure of the normal structure parenchyma of the pancreas: homogeneous and lobular.

homogeneous

Parenchyma with a uniform dense arrangement of small and medium signals, and the echogenicity of the gland is somewhat higher than the echogenicity of that of the left lobe of the liver.

Lobular

The parenchyma has a lobulated, islet structure, consists of well-defined medium and large lobules, separated by delicate echogenic septa, with this structure, the echogenicity of the gland is often lower, the same as the echogenicity of the left lobe of the liver.

It should be noted that both types of echostructure are found only at a young age in practically healthy people. With age, the echogenicity of the structure becomes higher due to an increase in density due to the growth of connective tissue. We noted that in 41% of the examined patients without any complaints and clinical manifestations on the part of the hepato-, cholecysto-, pancreato-, duodenal zone, the structure of the parenchyma of the gland was fine-grained diffusely highly echogenic, and 2.6% of them had normal or slightly below normal weight, 36.2% were overweight (obesity of varying degrees, and the degree of obesity did not affect intensity of echogenicity), 3.2% suffered diabetes varying degrees of severity (the severity of diabetes mellitus also had little effect on the intensity of echogenicity, especially since in some patients the structure of the pancreas was absolutely normal echogenicity, that is, close to the echogenicity of the normal structure of the left lobe of the liver).

Normal echostructure of the gland was also found in patients with diabetes mellitus of central etiology (silent pancreas).

This can be explained by the absence of damage to the islets of Langerhans. High echogenicity of the structure was also noted in alcoholics, regardless of body weight, in men who consume a lot of beer, in some children who consume a lot of sweets.

ducts of the pancreas

On the echogram, in the middle of the gland, the main duct is located (not always) in the form of two narrow linear echogenic reflections, in the center of which a narrow anechoic strip (content) is located, going to the head. The width of the duct is 1.5-2 mm. Secondary ducts are not located. Normally, it is very rare to detect the fusion of the main duct of the gland with the common bile duct.

Reasons preventing good visualization of the gland:

- dense subcutaneous fat layer;

- extensive rough post-burn or postoperative scars front abdominal wall;

- intestinal flatulence, accumulation of gas in the transverse colon, gastroptosis, gastrostasis;

- giant ovarian cysts that fill the entire abdominal cavity;

- ascites, peritonitis, cancer of the intestine, in particular the duodenum;

- a significant increase in the left lobe of the liver and spleen;

- an increase in lymph nodes in the gates of the liver, etc.

Pathology

For a pathologically altered pancreas, it is characteristic:

• change in contours, which can be uneven, intermittent, vague and bumpy (oval-convex);
• change in magnitude, local or diffuse;
• change in echogenicity - more often in the direction of its decrease, violation of the homogeneity of the structure;
• change in the ducts - thickening of the walls, local or diffuse expansion of the main and secondary ducts;
• involvement in the process of nearby organs (stomach, duodenum, extrahepatic bile ducts, gallbladder, liver, intestines, spleen vessels).

Malformations

Congenital pathology of the pancreas, which can be detected using echography, is extremely rare, it includes:

hypoplasia and hyperplasia

It is characterized by a decrease or increase in the volume and area of ​​the gland in comparison with the average due values ​​for this age. If a change in these parameters does not lead to violations of the function of the gland, then these conditions are not taken for pathology.

annular pancreas

It is extremely rare. At the same time, the gland tissue in the form of a ring envelops the duodenum at any level, leading to serious complications.

This malformation can be difficult to differentiate from head cancer that has grown into the wall of the duodenum.

Aberrant pancreas

It is extremely rare, and sonographically, one can only assume its presence, if, along with the existing gland in the wall of the duodenum, the gallbladder, a small size (up to 2.5 cm) rounded increased echogenicity is found, similar to the echostructure of the pancreas.

Double pancreas

We have not found a description of this anomaly in the available literature. We found a doubling of the body, tail and main duct with one head of the gland (one case) and two full glands located in parallel in the classical anatomical location (one case).

Cystic dilated ducts

This defect can occur in the form of local cystic dilatations of segments of the duct or a diffuse lesion, when the entire duct is unevenly cystically dilated. May be associated with cystic lesions of the extrahepatic bile ducts, more often common bile. An anomaly in the development of the pancreatic duct is considered true if these changes are found in early age or in an adult if there is no history of acute pancreatitis.

Congenital cysts

The echocardiography of congenital pancreatic cysts is no different from that described in other parenchymal organs. A cyst is a round formation, usually small in size, from 5 mm to 5-6 cm, with anechoic contents. The walls as such are absent and are formed from the tissue of the gland.

A cyst is considered congenital if it is detected early. childhood. Experience shows that with good visualization of the pancreas, cysts of any etiology from 3-5 mm can be detected in 100% of cases. However, given the anatomical proximity of the organs and vessels adjacent to the area of ​​the pancreas, the researcher is required to pay utmost attention when interpreting the scan data, since a cyst can be taken as a cross section of the portal, inferior vena cava and splenic veins, abdominal aorta, a cross section of the dilated common bile duct, duodenum, intestinal loops, fluid in the stomach with poor evacuation, polycystosis, multicystosis and hydronephrosis of the 2nd-3rd stage, etc. Only a thorough scan in different positions of the body, the selection of clear boundaries of the pancreas and nearby organs, knowledge of the anatomy and topography of blood vessels of the upper floor of the abdominal cavity in the transverse scan can protect the analysis of the results from errors that are fraught with disastrous consequences for the patient.

Polycystic

In the projection of the pancreas, many different sizes of cysts are located, creating a picture of a honeycomb, usually found in generalized polycystosis of parenchymal organs. In our practice, two cases of polycystic pancreas in combination with polycystic liver, kidney, spleen and ovaries were identified in a 43-year-old child, who was observed sonographically for 16 years, and in a 9-year-old child.

Damage

They are rare and are caused by closed or open injuries. With light closed injuries on the first day, a change in echogenicity and size is rarely detected. Usually, on the second day, the gland increases in size, the contours are somewhat erased, and against the background of the echogenicity of the parenchyma, a weakly echogenic, rounded formation with uneven contours (hematoma, necrosis) is located.

With progression, an echocardiogram develops. acute inflammation.

In severe closed injuries associated with a complete transverse rupture, only the head and part of the body can be located in the first hours. A few hours later, due to bleeding and leakage of pancreatic juice, a shapeless formation of weak echogenicity is located in the projection of the pancreas, and fluid is located in the abdominal cavity (, pancreatic juice).

open injury

From open injuries stab wounds are of echographic interest.

If a sharp object has passed through the parenchyma of the gland, then a hypoechoic rounded formation with fuzzy contours (hematoma) is located at the injection site.

If the capsule is damaged, the contours of the gland at the injection site are interrupted. After 2-3 days, a picture of acute pancreatitis usually develops.

The principle of ultrasound (ultrasound) is that the ultrasonic sensor generates sound vibrations high frequency and sends them to the studied tissues.

The same sensor receives the frequencies reflected from the organs, converting them into a picture on the screen. Reflected ultrasound is like an echo in nature. Therefore, ultrasound is also called echography.

The assessment of ultrasound data is very subjective, depending on:

• frequencies of ultrasonic waves generated by the device: the higher the frequency, the better the clarity of the picture on the screen, the lower, the deeper its penetration into the tissues
• anatomical features of the patient (for example, the heart will be difficult to see with emphysema)
• sonologist qualifications
• information about the patient's symptoms, chronic diseases: this will help the sonologist not to miss the organ (organs) in which there may be a potential pathology.

During the study, not only the location and size of the organ, but also its structure are evaluated. It is estimated using the concept of "acoustic density".

This term describes the speed of the ultrasonic wave in the examined tissue (organ). Acoustic density (echogenicity) for each organ is different.

For example, in the liver, sound travels at a speed of 1570 m/s, and in adipose tissue - from 1476 m/s. This can be seen on the screen using different shades. The sonologist knows what the echogenicity should be for each organ, whether it should be homogeneous in the norm, or not.

What does the phrase “echo-reduced (or hypoechoic) formation” mean? This term indicates that in the whole organ (or cavity) there is an area with reduced acoustic density. It appears as a darker (compared to the surrounding tissue) structure.

What are areas of reduced density

Let's repeat once again what "structure with reduced echo density" means. This is some area in which ultrasound moves more slowly than in the surrounding space.

Such characteristics have a liquid structure. Most often (but not always) it is a cyst, that is, a cavity that has thin walls of tissue similar to the mucous membrane, which is filled with fluid.

Why doesn't the sonologist write "cyst"? Because this diagnosis can only be made according to the data of such a study, in which the researcher will see this area not indirectly (as with ultrasound), but directly. This can only be a biopsy (it gives an almost 99% guarantee), or a study conducted using video endoscopic technology (laparoscopy, bronchoscopy, cystoscopy).

Let's get back to education. After indicating that such a site with liquid was found in some organ under study, the doctor must also indicate its other characteristics: its shape and contours.

So, a rounded formation suggests that it could be:

If it is described as a structure with uneven contours, this indicates that the liquid formation can be:

• cyst
• adenosis of the mammary gland
• tumor
• fibroadenoma of the breast.

Description of the ultrasound structure of the thyroid gland

If in the description of the ultrasound thyroid gland there is the word “structure with reduced acoustic density”, this should not be immediately frightened. This term in relation to this body may refer to:

• cyst
• liquid structure
• vascular formation
• only in 5% of cases - oncological pathology.

In this case, your actions should be as follows:

1. endocrinologist consultation
2. blood from a vein for hormones such as TSH, antibodies to thyroglobulin, triiodothyronine and T4.

If there are no abnormalities in the level of hormones, you need to do another ultrasound of the thyroid gland after 6 months. If the hypoechoic formation is again determined, it is located in the same place, has the same size or 1 cm more, it is necessary to study such a node using a biopsy. This is especially important if the described structure has fuzzy contours or an inhomogeneous structure.

What are the deviations in the structure of the uterus

The detection of a node with reduced echogenicity in the uterus usually indicates that a tumor has developed in the organ. It can be either malignant or benign.

1. Carcinoma is usually described as a structure with an indistinct shape. At the same time, there is an increase in M-echo and expansion of the uterine cavity. The structure of the endometrium is described as heterogeneous.
2. If an ultrasound describes a hypoechoic zone that has an internal echostructure, this is usually inflammation of the uterus.
3. Uterine fibroids, localized in its wall, will also look like a hypoechoic area.
4. An area with reduced echogenicity is found near the fetal egg - a sign that blood has accumulated under the embryo, which indicates a miscarriage.

Deviation occurred in the structure of the breast

If an ultrasound mammography revealed a breast structure in which the echo density is reduced, this may indicate the following pathologies:

• carcinoma of the gland: hypoechoic, has a fuzzy and uneven contour, acoustic shadow, is heterogeneous in structure. Not all signs must necessarily occur, and in addition, there are states with a similar description. In order to clearly consider the formation, it is necessary to remember on which day of the cycle to do an ultrasound of the mammary glands
• adenosis has similar features: hypoechogenicity, fuzzy contours and borders, often irregular shape
• typical cyst: reduced echogenicity, clear contour, rounded shape
• atypical cyst with suspicion of its malignancy: rather thick walls of the formation, growths inside it, calcifications
• fibroadenoma: has a clear and even contour; very similar to malignant tumor with limited growth.

Preparation for an ultrasound of the mammary glands is not needed, therefore, if such a pathology is detected, you can undergo a second examination next month, and if it shows the same, a biopsy should be performed.

Pathology of the structure of the ovary

A similar area in the ovary with reduced echogenicity can be:

• follicle
• vascular formation
• luteal body
• cyst
• very rarely - cancer (more often it has a different description).

If the structure is found in the kidney

If an area of ​​low ultrasound density is found in the kidney, it may be either a cyst or a tumor. The first most often has clear boundaries and a homogeneous structure, while the second is vice versa. Enlarged retroperitoneal lymph nodes will also speak of a poor-quality process. When conducting additional Dopplerography, the blood flow in the formation will not be determined.

To differentiate one pathology from another, it is not enough just to do an ultrasound of the kidneys (read also the information on how to prepare for an ultrasound of the kidneys). It is necessary to carry out computed tomography, angiography. If necessary, a biopsy is performed under ultrasound guidance.

Pathology of the pancreas

Here are the main conditions in which a similar structure with reduced acoustic density can be determined in the pancreas:

1. tissue metastases: the formation does not occupy the entire pancreatic tissue; it is hypoechoic, it has blurred borders
2. cyst: smooth contour and homogeneity (without inclusions) of education
3. several areas of a hypoechoic structure indicate either hemorrhagic pancreatitis or a fibrolipomatous process in the gland
4. cancer of the gland: the formation has thin peripheral outgrowths, the gland is enlarged before it, there is a displacement of large vessels that feed the gland itself. If you do not just an ultrasound of the pancreas, but also dopplerography, the blood flow in this structure will not be determined.

Violation of the structure of the liver tissue

The detection of a site with reduced echogenicity in the liver indicates the possible development of such a pathology:

1. These are the remaining areas of normal tissue against the background of fatty infiltration of the organ. Their features: detection in the area near the portal vein or gallbladder bed, they are most often triangular or oval in shape.
2. Nodules in cirrhosis: hypoechoic, rounded, may be lumpy on the periphery.
3. Cysts with hemorrhages: the contours are even, there are internal echoes.
4. Thrombosis of the intrahepatic portion of the portal vein: the echo structure is loose, the shape is oval, round or elongated.
5. Abscesses: there are areas of different echogenicity, often contain gas bubbles, the edges are uneven, the membrane is echogenic.
6. Nodular hyperplasia is not the norm for ultrasound of the liver. The area is hypoechoic, the shape is round, the contours are even. There are echogenic outgrowths that stretch to the periphery.
7. Adenoma: homogeneous, with smooth borders, small signals can be determined inside.
8. Liver cancer: heterogeneous formation, areas of hemorrhage, calcifications can be determined in it. Local lymph nodes are also changed, ascites can be determined.
9. Metastases: irregular borders, sometimes there may be a hypoechoic contour. The liver tissue is not changed.

Thus, hypoechoic formation can be any pathology. Basically, it is a cyst or tumor, but there may be other conditions: as requiring surgical treatment as well as those treated with medication. In order for a sonologist to make a clear picture of the pathology found, a person must carefully prepare for the study, taking into account all the nuances.

On the video: focal neoplasms of the kidney on ultrasound.

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2 pregnancy screening

Preparation for ultrasound of the kidneys, preparation for the study

How is an ultrasound of the intestine done?

Should I be afraid before an ultrasound of the kidneys

What is transvaginal ultrasound

What it is corpus luteum in the ovary

What you don't know about folliculometry

Deciphering fetal CTG

Fetometry of the fetus by week (table)

Ultrasound of the thyroid gland, normal (table)

How long does an ultrasound show pregnancy

How is a duplex scan of the vessels of the head and neck done?

What is anechoic formation

What is a hypoechoic formation

M-echo of the uterus, normal

The size of the liver is normal in adults on ultrasound

Ultrasound of the mammary glands on which day of the cycle is done

Ultrasound of the stomach, preparation and passage

How to check the intestines on ultrasound

How to do prostate ultrasound

CTG 8 points - what does it mean?

Ultrasound during pregnancy - what is it?

Ultrasound of the vessels of the head and neck, how to do

Decreased echogenicity of the pancreas - hypoechoic formation

In the process of ultrasound examination of the pancreas, it is mandatory to compare its echogenicity with the liver and gallbladder. Separately from other digestive organs, sonography of the gland is not performed, since it is absolutely uninformative. If during the ultrasound of the pancreas and its comparison with the liver it was found that the gland has a hypoechoic structure, this may indicate acute pancreatitis. Also, acute pancreatitis is characterized by a loss of definition of the contour of the gland, which does not prevent the pancreas from being well visualized. Gradually, with the progression of the disease, the contour line continues to disappear.

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

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

With the progression of acute pancreatitis, the size of the organ also increases, 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 veins.

Also, areas of reduced echogenicity will also be found 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 with pancreatic sonography it is possible to consider an area of ​​reduced echogenicity that is not associated with diseases of the gland. This site is the main pancreatic duct, which is visualized as a hypoechoic tube with a diameter of 1.3 mm. With age, the duct expands, but normally should not be wider than 2 mm. Sometimes the pancreatic duct is visualized as a thin line.

Increased echogenicity of the pancreas is usually found in chronic pancreatitis. However, she can date.

On examination internal organs significant indicator echogenicity is considered, which provides an opportunity to assess the density of the organ under study. Changes.

Ultrasound for suspected pancreatitis is performed to determine if the patient has this disease. If a.

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Ultrasound result: echogenicity of the pancreas is reduced

One of the main indicators of ultrasound examination of internal organs located in the peritoneal cavity is the level of echogenicity. Any change in it, up or down, 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 reduced or increased, what it is and what pathologies can lead to a change this indicator.

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

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

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

So, 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 smooth contours. An increase in echogenicity, or hyperechogenicity, manifests itself as a lighter area, up to white shades.

It is important to remember that the norm of the pancreatic 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 values.

Causes of pathological changes in the level of echogenicity

The development of the following pathological processes can lower 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) acute or chronic nature of the course;
• the development of a tumor-like neoplasm;
• a progressive stage of lipomatosis, that is, the replacement of glandular healthy tissues of the gland with fatty tissues;
• necrotic lesions of the parenchyma.

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

Varieties of hypoechoic formations

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The detection of a hypoechoic structure of the pancreas during an ultrasound examination may indicate the development of an acute form of pancreatic lesion of this organ. Moreover, the acute form of pancreatitis is accompanied by a loss of definition of the contours of the gland, which prevents a full study of the parenchymal organ. Over time, with the progression of this pathology, the contour lines of the gland become more and more blurred, up to the complete absence of the possibility of their visualization.

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, destructive disorders with an inflammatory course begin to develop in the gland.

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

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

Zones of hypoechoic formations are also detected in 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 in the gland increases. Basically, this happens with the development of acute pancreatitis, or manifestations of severe allergic reaction with existing hypervolemia, that is, advanced level water content in the body.

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

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• cystic lesion of the parenchyma;
• development of a pancreatic cyst;
• the occurrence of a tumor-like neoplasm;
• an increase in the diameter of the ducts of the gland under study.

It is important to remember that the focal variety of the ability of the gland to reflect ultrasound can be not only reduced, but also increased, depending on what kind of tumor-like neoplasm is taking place.

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 research feces, urine and blood, as well as on the basis of the diagnosis.

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

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

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

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

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 malnutrition and eating excessive levels of fast carbohydrates and fast food.

Nausea, abdominal pain, heat, intoxication is all pancreatitis. If the symptoms are "on the face" - perhaps your pancreas is no longer able to work normally. You are not alone, according to statistics, up to 15% of the entire population of the planet suffers from problems in the work of the pancreas.

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Is hypoechoic inclusion so scary

A formation labeled hypoechoic is nothing more than a rather low-density structure (compared to its surrounding tissues). Depending on the location, this formation can be both a variant of the norm and a serious pathology.

What it is

A liquid formation is endowed with a reduced echo density. Often it is a cyst, but it is impossible to immediately make an accurate diagnosis. Only according to the results of biopsy, laparoscopy, cystoscopy and other studies, it is possible to draw final conclusions about the presence or absence of cysts.

Having diagnosed the liquid structure in any organ, in the conclusion of the ultrasound, the doctor must mention the contours, shape and size of this neoplasm.

For example, the inclusion of a rounded shape could be:

When an inclusion has non-uniform boundaries, it can be denoted as follows:

It should be noted that the latter option (fibroadenoma) is considered a precancerous condition of the body.

Changes in the thyroid gland

Revealed dark spot on the ultrasound image, it is an inclusion with reduced acoustic density. This should not be frightened, since the conclusion of a sonologist is only the result of an examination, but not a diagnosis. Discovered area in thyroid gland can be:

• cyst or other liquid formation;
• nodal formations;
• oncological deviations (only in 5% of patients).

After the examination, it is necessary to get a consultation from an endocrinologist, as well as donate blood for some hormones. If the results of the analysis are within the normal range, an ultrasound examination of the thyroid gland should be performed in six months.

If a second ultrasound also reveals a hypoechoic thyroid mass located in the same place and not greatly increased in size (by 1 cm), a biopsy will be required. Also, do not ignore the heterogeneous structure and poorly defined boundaries of hypoechoic nodes.

Changes in the structure of the uterus

A structure with reduced echo density (hypoechoic) in the indicated organ is often a tumor-like formation. Moreover, it is both good and malignant.

A hypoechoic formation detected by ultrasound of the uterus is described in different ways, depending on its size, shape, location and structure. Such an area could be:

• inflammation;
• fibroids (grows in the wall of the uterus);
• progressive miscarriage (an area with reduced echogenicity is localized near the fetal egg, blood accumulates).

Uterine cancer is characterized by blurred boundaries of the neoplasm, expansion of the organ cavity and an increase in the thickness of the endometrium. At the same time, the structure of the latter is rather uneven.

Deformation of the structure of the mammary glands

Hypoechoic formation in the mammary gland is a common occurrence. The resulting area can be a sign of the following pathologies:

• Crayfish. The inclusion is heterogeneous, casts an acoustic shadow, the contours are blurred. When diagnosing, the day of the cycle matters.
• Adenosis. Signs are similar, often irregular in shape.
• Benign cyst. The shape is round, the contours are clear, echogenicity is reduced.
• Atypical neoplasm. The walls are thickened, there are growths inside and deposits of calcium salts. Malignancy is not ruled out.
• Fibroadenoma. Contours are clear, well-defined.

There is no need to do any special preparation for an ultrasound of the mammary glands, but you need to know what day to do an ultrasound of the mammary glands. If hypoechoic formations are detected, a second ultrasound is possible in a month. If the results do not change, a biopsy is necessary.

Changes in the structure of the spleen

Echogenicity on ultrasound of the spleen is homogeneous and slightly higher than that of the liver, but this is a variant of the norm. Hypoechoic inclusion in this case is:

• intraparenchymal hematoma in acute form. It is a consequence of an injury to the abdomen, occurs when an organ ruptures.
• Benign vascular formation (hemangioma).
• Lymphoma of the spleen.
• Organ infarcts.
• Various metastases (osteosarcomas, sarcomas, etc.).

According to experts, cystic formations of dermoid, solitary and echinococcal nature in the spleen have a mixed echostructure.

Pathology in the ovaries

Typically, a hypoechoic mass on ovarian ultrasound may be:

• cyst;
• unruptured follicle;
• luteal body;
• carcinoma (rare).

If the patient is of reproductive age, the heterogeneous structure of the organ is the norm. During menopause, everything is exactly the opposite.

In order to timely diagnose a hypoechoic formation in the ovary, as well as other pathologies of the organ, it is necessary to conduct its ultrasound annually.

Pathologies in the kidneys

In the kidney, an area of ​​low density is either a cyst or a tumor-like mass. Only the cyst has the same, uniform structure and evenly outlined contour. The characteristics of the tumor are completely opposite, and the position is complicated by enlarged retroperitoneal lymph nodes. It will not be possible to detect blood flow in a Doppler study.

In order to accurately determine the nature of the neoplasm, it is not enough just to do an ultrasound examination of the kidneys. Angiography, computed tomography, and a biopsy may also be required.

Changes in the pancreas

The acoustic density of any area decreases in the presence of the following pathologies:

• Metastases. The formation is hypoechoic, has an implicit contour, occupies part of the tissue of the organ.
• Cyst. The boundaries are clear and even, the structure is homogeneous.
• Hemorrhagic pancreatitis or fibrolipomatous process in the organ.
• Carcinoma. The organ is enlarged, the vessels feeding it are displaced.

If cancer is suspected, in addition to ultrasound of the pancreas, a Doppler examination should be performed. If the patient has developed a carcinoma, the blood flow in the neoplasm will not be determined.

Changes in the liver tissue

Quite often reveal hypoechoic education in a liver. It may indicate such pathologies that have arisen:

• Nodes. They appear with cirrhosis, have a rounded shape, a bumpy structure is possible along the edges.
• cysts. Hemorrhage is observed, the boundaries are even and clear.
• Thrombosis. The intrahepatic region of the portal vein was affected. The formation is oval, round or elongated, its structure is heterogeneous (loose).
• Abscesses. There are areas of different echogenicity, there are gas bubbles. The contours are blurry.
• nodular hyperplasia. Round shape, clear and even borders. Echogenic outgrowths extend to the periphery. It is not the norm for ultrasound of the liver.
• Adenoma. The contour is clear, the structure is homogeneous. Signals are detected inside the inclusion.
• Carcinoma. Heterogeneous, has areas of hemorrhage, deposits of calcium salts. Local lymph nodes are deformed, ascites is not excluded.
• Metastases. Borders vary, hypoechoic. Organ tissue is not deformed.

Important: A hypoechoic area can occur in any human organ. Tumor-like formations and cysts are more common, but other pathologies are not excluded. Some of them eliminate drug therapy, to get rid of others, surgery will be required. To get the most accurate results and specify the condition, the patient needs to properly prepare for the ultrasound procedure.

Cysts of the pancreas. The most common are congenital (dysontogenetic), retention and false cysts of the pancreas. Congenital cysts are an anomaly in the development of the pancreas and are often combined with cysts of other organs (liver, kidneys); occur in people of all ages, are single and multiple. Retention cysts develop when there is an obstruction in the ducts of the gland, which occurs mainly as a result of inflammatory changes and fibrosis.

Pseudocysts make up about 79% of all cysts. They do not have their own shell, the surrounding tissues serve as a wall. Pseudocysts are formed due to tissue breakdown during pancreatic necrosis or as a result of hemorrhage into the affected gland. Most common cause formation of pseudocysts (in 76% of cases) is pancreatitis (Shalimov A.A.).

The experience of using echography shows that the diagnosis of cysts usually does not present any difficulties. They are defined as oval or round, well-defined, echo-negative masses free from internal structures. The inner surface of pseudocysts is usually smooth. However, in some cases, mainly in the region of the posterior wall, an uneven contour can be determined due to the involvement of adjacent organs in the pathological process. The size of the cysts is different. Their diameter ranges from several mm to 20 cm or more. separate thin partitions are revealed in their cavities.

In isolated cases, a delicate fine suspension is determined inside the cysts, the appearance of which is due to the presence of blood or pus. With a long stay of the patient in the same position, sedimentation of the suspension sometimes occurs, as a result of which a level of stratification of the liquid part and the suspension is formed.

It should be borne in mind that in some cases, cysts, especially small ones, in their echographic image may resemble a tumor. However, the strengthening of the contour of the far wall indicates the liquid nature of the formation.

Sometimes with cysts that reach very large sizes, there may be significant difficulties in establishing their connection with a particular organ. This task is somewhat facilitated by the use of real-time scanning systems. At the same time, it should be borne in mind that in the presence of giant liquid formations due to a pronounced change in the topography of the abdominal organs, the diagnosis of a cyst can only be made presumably.

In some cases, a pancreatic body cyst may be mistaken for a fluid-filled stomach. To differentiate these fluid formations, it is necessary either to suck out the contents of the stomach, or fill it with water. When applying the first of these procedures and the presence of a cyst, the nature of the formation does not change, while when the stomach is filled with water, the scans reveal two echo-negative formations, one of which will be a fluid-filled stomach and the other a pancreatic cyst.

Rare complications of pancreatic cysts include the occurrence of ascites and hydrothorax. In single observations with cysts of the pancreatic head, jaundice can be observed, the occurrence of which is due to compression of the common bile duct.

On the echograms in these cases, along with the cyst, the appearance of an enlarged common bile and intrahepatic biliary ducts is noted.

The accuracy of diagnosing pancreatic cysts is 96%. The minimum size of a cyst located in the head and body of the pancreas, which can be established using echography, is 0.6-0.8 cm and in the tail - 1-2.5 cm.

Tumor of the pancreas. Sonography can be of value in diagnosing pancreatic tumors. It is characterized in most cases by a local increase in any part of the gland. There is also a diffuse lesion of the entire gland by a tumor. No tumor has a completely even contour. The echostructure of the organ is changing. According to the reflected echoes, the echostructure of the tumor can be divided into several types: 1) it almost completely does not contain echoes - the most common type; 2) diffusely scattered echoes with low level intensity; 3) against the background of echo signals of low intensity, there are echo signals of increased intensity. All ultrasound signs of a pancreatic tumor are also divided into 2 groups:

1. Main features: a) local enlargement of the pancreas, b) irregularity of the tumor contour, c) change in the echostructure according to one of the selected types;

2. Additional signs: a) signs of biliary hypertension (enlarged gallbladder, dilatation of the intrahepatic bile ducts); b) dilated pancreatic duct; c) compression of the inferior vena cava, splenic, mesenteric and portal veins, superior mesenteric artery; d) displacement of the superior mesenteric artery and vein; e) duodenostasis; e) liver metastases. Identification of additional features depends on the localization of the process. The presence of liver metastases indicates an advanced stage of the tumor process and its spread beyond the pancreas.

Pancreatic cancer occurs infrequently. In most cases (50-80%), it affects the head, less often the body and tail of the pancreas. The conducted echographic studies show that the most characteristics tumors should be attributed to an increase in any part of the pancreas and the unevenness of its contours. The presence of a tumor may be indicated by a local increase in the head of the pancreas up to 4 cm, body - up to 3 cm and tail - up to 3.5 cm or more.

In most cases, a pancreatic tumor is detected as a formation that is almost devoid of echostructures or contains a small amount of them. Therefore, due to its homogeneity, it can often be mistaken for a pancreatic cyst. However, the roughness of the contour and the absence of reinforcement of the far wall indicate its solid origin.

In some cases, with small tumor sizes, i.e. its diameter is not more than 1-1.5 cm, the presence of a malignant formation may be indicated by the appearance in the pancreatic tissue of a very small, indistinctly contoured area, which differs from the normal parenchyma only by a slightly reduced echogenicity.

The minimum size of a tumor located in the head and body of the pancreas, which can be established using echography, is approximately 1-1.5 cm and in the tail - 1.5-2 cm. However, in some cases tumors of smaller sizes can be detected. At the same time, it should be noted that if the tumor diffusely affects the pancreas, then it is rarely detected by echography. In these cases, the diagnosis of chronic pancreatitis is usually made.

Cystic neoplasms account for 1% of all pancreatic cancers, this group includes microcystic (serous) adenomas, which belong to benign tumors, or macrocystic (mucinous) cystadenomas or cystadenocarcinomas Mucinous lesions may be benign or low-grade and difficult to distinguish when histological examination; therefore shown surgery. Both serous and mucinous tumors occur in middle-aged patients, mostly women.

Of particular interest regarding diagnostic capabilities various methods research in identifying early stages pancreatic cancer are data obtained by A. R. Moossa and V. Levin (1981). When using echography, an accurate diagnosis of the presence or absence of pancreatic cancer was made in 86% of patients and an erroneous one in 10%; with computed tomography, these figures were respectively equal to 80 and 8%, with angiography - 73 and 0%, retrograde cholangiopancreatography - 89 and 16%. The results of these studies indicate that echography is not only not inferior to all the indicated research methods, but even somewhat surpasses them in terms of information content.

Metastases in the pancreas. Metastases in the pancreas are not very common. The primary tumor can be melanoma, hypernephroma hepatoma and sarcoma, cancer of the ovaries, lung, mammary glands, prostate. They usually appear as hypoechoic masses indistinguishable from a primary pancreatic tumor.

Islet cell tumors. Islet cell tumors are slowly progressive tumors that are very likely to become malignant. The five-year survival rate is 44%. These are solid tumors that develop from multipotent stem cells in the epithelium of the duct, the so-called cells of the APUD system. These tumors secrete hormones that can determine clinical symptoms. Possible variants of tumors in this group are insulinoma, gastrinoma, glucagonoma, somatostatinoma, vipoma (apudoma), and adrenocorticotropic hormone-producing tumor. 70% of islet cell tumors are insulomas, 18% are gastrin-secreting, and 15% are non-functioning. Functioning and non-functioning islet cell tumors are usually small, may be cystic, solid, or mixed, and contain calcifications. In Zollinger-Ellison syndrome, 42% of tumors are visible sonographically, while only 30% of non-functioning islet tumors can be identified by ultrasound. In cases of non-functioning tumors, angiography is a more valuable method of investigation. On ultrasound, an islet cell tumor usually appears as a well-demarcated hypoechoic mass of small size (less than 2 cm) and is highly vascularized on color Doppler angiography.

Therefore, the presented data indicate that echography is a valuable research method, the use of which in the vast majority of cases allows us to establish the presence of acute pancreatitis, cysts and stones of the pancreas, tumor lesions of the pancreas. At the same time, there are significant difficulties in diagnosing chronic pancreatitis and small tumors, especially of the pancreatic tail. Therefore, if these diseases are suspected and echography results are negative, the use of other research methods should be considered indicated.

DOPPLEROGRAPHIC EXAMINATION OF THE PANCREAS.

It is not always possible to visualize the small vessels of the pancreas. The frequency of detection of blood flow in the organ arteries in color modes is normal both in the head and the body of the pancreas is high, in the tail region it is much lower. This may be due to several reasons: 1) inconvenience of acoustic access; 2) deep location; 3) a relatively poorer vascular network than in the area of ​​​​the body, and even more so the head of the gland. Under these conditions, there is some advantage of power Doppler over color Doppler mapping. In addition to the number of detected color signals in the parenchyma of one or another section of the gland, the nature of the distribution of the identified vessels is also important.

In normal pulsed wave Doppler ultrasound, the peak systolic blood flow velocity in the gastroduodenal artery is 89 ± 24 cm/s, the final diastolic velocity is 19 ± 16 cm/s, the resistance index is -0.75 ± 0.6, and the pulsation index is 1.71 ± 0 ,28.

Peak systolic blood flow velocity in small arteries is 30 ± 1 cm/s, blood flow velocity in small veins is 15 ± 1 cm/s. The resistance index in the small arteries of the head of the pancreas is 0.62 ± 0.05, in the body - 0.63 ± 0.03, in the tail - 0.61 ± 0.04; the pulsation index in the small arteries of the head of the pancreas is 1.21 ± 0.12, in the body - 1.19 ± 0.1, and in the tail - 1.11 ± 0.13.