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Diagnosis of the pancreatic cyst
Last reviewed: 23.04.2024
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Laboratory studies are poorly informative in the diagnosis of pancreatic cysts and at best reveal signs of chronic pancreatitis: violations of the external and intrasecretory functions of the pancreas.
The main importance in the detection of pancreatic cysts is ultrasound and CT (unfortunately, as a relatively new diagnostic method, it is not yet available in all hospitals in the country). In some cases, as mentioned above, the exclusion from the usual position of some organ, usually located in the epigastric region or the left upper quadrant of the abdomen, may cause the radiologist to suggest that the patient may have a tumor or pancreatic cyst. In addition, with survey radiography, it is sometimes possible to detect calcification sites or separate small foci of deposition of calcium salts in the zone of ex-necrosis after acute pancreatitis or another exacerbation of chronic recurrent pancreatitis; areas of calcification are sometimes found in the wall of the cysts formed. Such research methods as tomography with pneumoperitoneum, scanning for the detection of pancreatic cysts, are almost not used at present. ERCPHG in pancreatic cysts, especially after inflammatory and traumatic, is unsafe, since the introduction of contrast into the gland ducts in the direction opposite to the current of pancreatic juice can cause an exacerbation of pancreatitis. However, this method, carried out by an experienced specialist, and with special indications, makes it possible to establish a connection between the cyst and the pancreatic duct. Angiography for the detection of pancreatic cysts is currently rarely used, but in cases especially difficult for diagnosis it sometimes allows you to clarify the nature of focal changes in the pancreas and confirm the presence of cysts.
[Differential diagnosis of the pancreatic cyst
Differential diagnosis is conducted between pancreatic cysts and tumors and cysts of nearby organs, omentum, retroperitoneal or intertissal intestinal abscess, tumors and cysts of the transverse colon mesentery.
Secondary differential diagnosis of the pancreas cyst is to establish the character of the cysts in each specific case, because with their etiological diversity, cysts of different origin are in fact only "external", most easily detected (especially with the help of modern instrumental diagnostic methods) by the manifestation of a number of completely various diseases. However, features of the symptomatology, anamnesis (past pancreatitis attacks, abdominal trauma, especially the epigastric region and the left hypochondrium zone), in some cases, some still not entirely clear elements of hereditary transmission of pancreatic diseases, including cysts, the presence or absence of polycystosis of other organs, echinococcosis to a certain extent help distinguish cysts of different origin. It is also necessary to take into account the comparative frequency of cysts: the most frequent (in dozens of times) are cysts that have arisen as a result of severe pancreatitis with foci of pancreatonecrosis, posttraumatic cysts, that is, pseudocysts, occur less frequently. Finally, modern instrumental methods of investigation - ultrasound, CT, etc. - allow in a number of cases to more accurately differentiate pancreatic cysts of different origin.