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24

Pancreas
Merrilee Holland

Department of Clinical Sciences, College of Veterinary Medicine, Auburn, AL, USA

24.1 Pancreatic Anatomy ventral and aiming the probe dorsally, the first longitudinal
small intestinal loop encountered will be the duodenum.
The pancreas has a body and two lobes or extremities. The The right limb of the pancreas will be medial to the
right lobe is similar in location to canine patients, lying descending duodenum (Figure 24.2a and b). To ensure that
adjacent to the descending duodenum. The body is associ- the duodenum has been identified, verify that it can be
ated with the pylorus, with the pancreatic duct entering followed cranially to the pylorus of the stomach. The body
along its cranial border. The left lobe of the pancreas lies of the pancreas lies medial to the junction of the duode-
along the greater curvature of the stomach, medial to the num with the pylorus (Figure 24.2c). With the cat still in
spleen and cranial to the left kidney. The pancreatic duct, left lateral recumbency, the portal vein can be identified by
not the pancreaticoduodenal vessel, courses centrally sliding further ventral from the duodenum and directing
within both lobes, unlike canine patients. The pancreatic the probe slightly dorsally, along the caudal border of the
and bile ducts join prior to entering the duodenum at the liver. The portal vein has echogenic walls and will bifurcate
major duodenal papilla. The major duodenal papilla lies a immediately after entering the liver. The left extremity of
few centimeter from the pylorus in the proximal descend- the pancreas will be found immediately ventral to the
ing duodenum. The accessory pancreatic duct, if present, portal vein (closer to the probe in the near field). The
enters near the proximal portion of the descending duode- pancreatic duct will be visualized centrally within the left
num caudal to the major papilla [1]. extremity and serves as a landmark (Figure 24.2c–f) [1].
To identify the left extremity in right lateral recumbency,
first locate the stomach in cross‐section then follow the
24.2 Normal Radiographic stomach from the fundus dorsally to the body ventrally.
Appearance The left extremity of the pancreas will be identified if
enlarged along the greater curvature of the stomach
Abdominal radiographic images are insensitive for identifi- (Figure 24.2e,f). The normal pancreas is more difficult to
cation of the normal pancreas. In obese feline patients, the identify from this scanning plane. The splenic vein can be
pancreas can occasionally be identified on the ventrodorsal seen coursing caudodorsally from the greater curvature of
view (Figure 24.1). the stomach with the left extremity of the pancreas just
ventral (deep to the vein). Be careful not to confuse the
normal spleen for the pancreas in this region [1].
24.3 Ultrasound Scanning Tips

Identification of the feline pancreas with ultrasound can 24.4 Normal Sonographic Appearance
be challenging. With the patient in left lateral recumbency,
the right extremity can be consistently visualized by first The echogenicity of the normal pancreas has been reported
obtaining a longitudinal image of the right kidney. The to be hypoechoic to isoechoic to the adjacent intraabdomi-
next step is to move cranially at this same level. By sliding nal fat and isoechoic to hyperechoic to the liver. The shape

Feline Diagnostic Imaging, First Edition. Edited by Merrilee Holland and Judith Hudson.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.