Pancreatic duct imaging during aging

Abstract

As part of the aging process, fibrotic changes, fatty infiltration, and parenchymal atrophy develop in the pancreas. The pancreatic duct also becomes wider with age. This article provides an overview of the diameter of the pancreatic duct in different age groups and different examination methods. Knowledge of these data is useful to avoid misinterpretations regarding the differential diagnosis of chronic pancreatitis, obstructive tumors, and intraductal papillary mucinous neoplasia (IPMN).

Keywords: EUS; aging; diameter; ductal adenocarcinoma; pancreatic duct.

Figure 1

A 75-year-old male. Arterial hypertension, diabetes mellitus type 2 requiring tablets, obesity, BMI 32. Sonography shows a hyperechogenic pancreas with lobulated contour. The diameter of the pancreatic duct is 1.9 mm in the pancreatic corpus. Independent factors for the hyperenhanced pancreatic parenchyma are age and BMI. BMI: Body mass index

Figure 2

An 80-year-old female. Urinary tract infection, increased renal retention parameters. Narrow pancreatic parenchyma, organ atrophy. Prominent pancreatic duct with a diameter of 2.3 mm on the left pancreatic body

Figure 3

An 80-year-old male. Arterial hypertension, chronic obstructive pulmonary disease. The pancreas is hyperechoic. The pancreatic duct is of normal caliber. The parenchyma around the pancreatic duct is hypoechoic. This is an expression of periductal fibrosis

Figure 4

A 79-year-old female. Anemia assessment. The pancreatic parenchyma is narrow. The pancreatic duct is prominent. The duct is delineated at 3.1 mm at the head of the pancreas (a) and 2.7 mm at the body of the pancreas (b). The bile duct was normal, the papilla Vateri inconspicuous. There was no juxtapapillary diverticulum. No mass was found on the head of the pancreas

Figure 5

Image of the pancreas of a 29-year-old woman without complaints (as part of an ultrasound course) (a). The pancreas has a smooth border, normal size. The ventral part is slightly hypoechogenic compared to the rest of the parenchyma. The pancreatic duct is very slim and can only be delineated after various maneuvers. Here, visualisation is successful by bulging the abdomen. In contrast, figure (b) shows the age atrophic pancreas of a 96-year-old slim woman, BMI 20. The pancreatic duct is prominently wide. The remaining narrow parenchyma is bright, hyperechoic. Diabetes mellitus was not present. BMI: Body mass index

Figure 6

A 40-year-old male. Nonspecific paraumbilical complaints. Deep inspiration is also used in the effort to optimally adjust the pancreas. This shows an increase in the diameter of the pancreatic duct during deep inspiration (b) compared to normal breathing position (a)

Figure 7

An 80-year-old female. Endosonography was performed to exclude choledocholithiasis. In the hypoechoic ventral part, the pancreatic duct had a maximum diameter of 3.7 mm. There was no outflow obstruction in the periampullary pancreatic parenchyma or in the papillary region. The duct was normal in the pancreatic body and tail

Figure 8

A 79-year-old female. Nonspecific upper abdominal discomfort. The pancreatic duct was up to 4.3 mm wide in the pancreatic body. Sonography and endosonography diagnosed no tumor. However, the conspicuous finding should be a reason for sonographic follow-up

Figure 9

A 72-year-old female. Acute pancreatitis. Imaging showed a prominent pancreatic duct on the left pancreas. Endosonography diagnosed a small infiltrative process on the left-sided pancreas. The upstream pancreatic duct was up to 4 mm wide. As this infiltrative process was not visible on imaging, EUS-FNA was performed, which revealed a ductal adenocarcinoma. Left pancreatic resection was performed. Histologically, the patient had a T1N0M0 stage

Figure 10

A 78-year-old female. Secondary event of acute pancreatitis. Sonographically, there was a prominent pancreatic (3, 1 mm) duct with a single calcification in the pancreatic body (a). Endosonographically (b) there was a 22 × 11 mm hypoechoic infiltrative process adjacent to the pancreatic duct and calcification which walled off the splenic artery

Figure 11

An 82-year-old female. Upper abdominal discomfort and mild lipemia. ultrasonography demonstrates a dilated pancreatic duct (a). At the head of the pancreas, an anechoic lesion appears, which contains internal structures (b). In CEUS, the internal structures are contrast-enhanced and thus correspond to solid tumor tissue (c). Endoscopy with a side-view duodenoscope diagnoses a fish mouth papilla (d). The primary cause of the pancreatic duct dilatation is a main duct intrapapillary mucinous neoplasia (MD IPMN) with solid tumor structures in the pancreatic head. CEUS: Contrast-enhanced ultrasound