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Methodology of ultrasound of the pancreas
Last reviewed: 04.07.2025
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There may be difficulty in visualizing the pancreas, especially the tail.
Begin with transverse sections across the upper abdomen, moving the transducer from one side to the other, from the costal margin to the umbilicus. Then make longitudinal sections, moving the transducer down and up the upper abdomen. If a specific area needs to be examined, ask the patient to take a deep breath and hold it as he or she inhales.
Gas
If gas in the intestines interferes with imaging:
- Use light pressure of the sensor or cuts in the lying position on the side, on the right and left.
- If necessary, give the patient 3 or 4 glasses of water, wait a few minutes for air bubbles to dissipate, then repeat the examination with the patient sitting or standing, visualizing the pancreas through the fluid-filled stomach.
- If the patient is unable to stand, place the patient on their left or right side and have them drink through a straw, then scan with the patient lying on their back.
Transverse scanning
Begin scanning transversely across the abdomen, moving the transducer down toward the patient's legs until the splenic vein is visualized as a linear tubular structure with a thickened medial end. At this point, it merges with the superior mesenteric vein at the level of the body of the pancreas. The superior mesenteric artery will be visualized in the transverse section just below the vein. By tilting and rotating the transducer, the head and tail of the pancreas can be visualized.
Continue scanning transversely downwards until the head of the pancreas and the uncinate process (if present) between the inferior vena cava and portal vein are imaged.
Longitudinal scanning
Begin the longitudinal scan just to the right of the midline, locate the tubular structure of the inferior vena cava with the head of the pancreas anteriorly, below the liver. The inferior vena cava should not be compressed or displaced by the normal pancreas.
Continue scanning longitudinally, moving to the left. Locate the aorta and superior mesenteric artery. This will help identify the body of the pancreas.
Scanning in a lying position
After performing longitudinal and transverse scanning, turn the patient on the right side and scan the pancreas through the spleen and left kidney. This will help to locate the tail of the pancreas.
Then, with the patient lying on his or her left side, ask him or her to take a deep breath and hold it, scan the pancreas through the liver. This will reveal the head of the pancreas.
Scanning in a standing position
When visualization is difficult due to intestinal gas, give the patient 3 or 4 glasses of water. After the patient finishes drinking the water, wait a few minutes for the air bubbles to dissipate, then with the patient sitting or standing, visualize the pancreas through the stomach. This technique is especially useful for visualizing the tail of the pancreas.
Visualization of the entire pancreas is always difficult. It is necessary to use different projections and angles of the transducer.
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