Current Approach to Examination & Interpretation of the Feline Pancreas with Ultrasonography

The feline pancreas is an interesting organ – and finding it, and interpreting findings with ultrasound is a common concern among a large number of veterinary practitioners. Specialist radiologist, Dr Lorrie Gaschen is one of the most outstanding imaging lecturers I have ever heard, and she provided a clear and precise roadmap on how to find the pancreas, and what it looks like in health and disease.

There were so many great tips given in the lecture, it would be hard to list them all – but here’s a few:

• In cats, the left limb of the pancreas is the largest
• It is important to scan the left limb of the pancreas to its far extremity, as some lesions may only be present at the most distal tip of the left limb – including pancreatitis, and neoplastic lesions
• To scan, have the patient in right lateral recumbency. 
  • Transducer – high frequency, curvilinear is best, with preferably a small footprint
  • Begin the scan with the transducer at the xiphoid in the midline sagittal plane
  • Identify the portal vein – which is commonly midline, and trace this cranially until the pylorus of the stomach is seen on the left. 
  • The body of the pancreas is found between the pylorus and the portal vein.
  • The left limb of the pancreas is located by a slight caudal ultrasound probe deviation to the left. Often the left limb of the pancreas will be seen with the stomach on one side, and the transverse colon on the other. The pancreas itself may look like a “mini-liver” in appearance
  • The right limb of the pancreas is found between the descending duodenum and the portal vein, just to the right of midline
• Some tips when interpreting the pancreas
  • Pancreatitis will not be ultrasonographically evident in all patients. Up to 50% of pancreatitis patients have an unremarkable pancreas on ultrasound
  • Patients may have the following
    • Abdominal effusion
    • Hypoechoic echogenicity – although the appearance could be normal, or may be mottled/uneven (especially with neoplastic lesions)
    • Pancreatic enlargement may be present. Diameter of >1cm in the body of the pancreas is considered abnormal
    • The mesentery around the pancreas may be bright – but this is inconsistent, and can be difficult to see
    • fPLI is recommended to aid in diagnosis
  • Pancreatic neoplasia may be present in association with pancreatitis
  • Repeated ultrasonography of the pancreas is recommended periodically if abnormalities are detected, or if clinical signs of illness persist.
  • Ultrasound the liver, duodenum and biliary tract for evidence of concurrent disease, such as triaditis, hepatopathy, IBD etc.

This lecture is so good, and so informative, it comes with a 5-star rating and is well worth the view!