Improved gray-scale instrumentation and high resolution real-time ultrasound has allowed accurate delineation of the pancreas and its relationships to surrounding structures.' Various authors have demonstrated the utility of sonography in demonstrating both normal and abnormal pancreatic d u ~t s . ~, ~ It has been shown that surrounding organs and vascular structures may be confused with the pancreas or the pancreatic d u ~t . ~-~
The posterior gastric wall is a routinely visualized structure that lies ventral to the pancreas and may be sonographically confused with the pancreatic duct. One is able to avoid this pitfall by being aware of the surrounding anatomy and following several maneuvers with high resolution real-time sonography.
CASE 1
A 44-year-old male with known alcoholic cirrhosis was hospitalized for increasing right upper quadrant pain. An ultrasound was performed to exclude cholecystitis or pancreatitis. A linear array real-time ultrasound examination demonstrated a tubular structure which appeared to represent a dilated pancreatic duct within the thickened pancreas. Because of this, additional ultrasound maneuvers were performed (Fig. 1).