Imaging Anatomy of the Pancreas
Ben Barnard
Department of Diagnostic Radiology; KHC
Outline
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Embryology
Variants
Gross anatomy
Anatomical relations
Arterial supply
Venous drainage
Lymphatic drainage
Radiological anatomy
Embryology
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The pancreas is formed by dorsal and ventral buds originating
from the endodermal lining of the duodenum
The smaller ventral bud arises in conjunction with the bile duct
and consists of two portions
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Left bud which atrophies during development
Right bud which swings posteriorly and unites with the inferior
division of the dorsal bud
Langman’s Medical Embryology
Variants
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Agenesis of the dorsal pancreatic moeity
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Left-sided pancreas
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Can occur in the wall of the stomach, duodenum, jejunum ,
appendix, Meckel’s diverticulum (1-15% )
Pancreas divisum
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Effect of age with laxity of suspensory fascia
Accessory nodules (pancreatic rests)
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Pancreas with a head but no body or tail – very rare
Failure of fusion of dorsal and ventral moeities
Anterosuperior head and body drain via accessory ampulla
Posterioinferior head drains to ampulla
Annular pancreas
Annular pancreas
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Occurs when the left portion of the ventral bud fails to
atrophy and migrates around the duodenum in the
opposite direction to the normal right portion
Duodenum is thus surrounded bypancreatic tissue, and
an annular pancreas is formed
This tissue constricts the duodenum and may cause
complete obstruction
Gross Anatomy
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Retroperitoneal
organ
15cm long
Transverse
mesocolon
originates from
anterior surface.
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Head
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Uncinate process
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Overlies L1 vertebral
body immediately to the
left of the head
Body
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Inferior-medial extension
of head under SMA (L2)
Neck
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C-curve of duodenum
(L2)
Extends left and slightly
superior (L1)
Tail
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Tapering portion
extending to hilum of
spleen (T12)
Various normal shapes
Anatomical Relations
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Anterior relations
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Peritonium
1st part
duodenum
Lesser sac and
stomach
Transverse
colon/mesocolon
Anatomical Relations
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Posterior relations
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CBD
IVC
PV
Aorta
SMA
SMV
Right renal vein
Left kidney
Crurae of
diaphragm.
Retroperitoneal Compartments
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The pancreas (P) lies in the
anterior pararenal space
(APRS) together with the
ascending and descending
colon (C) and duodenum
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ST = stomach
S = spleen
RK = right kidney
LK = left kidney
A = aorta
V = inferior vena cava
LS = lesser sac
PRS = perirenal space
PPRS = posterior pararenal
space
Grants Anatomy
Pancreatic duct
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Pancreatic duct measures
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3mm in the head
2mm in the neck
1mm in the tail
Unites with the common
bile duct to form the
ampulla of Vater and opens
into the 2nd part of
duodenum
Pancreatic duct variants
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Santorini
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Wirsung
Arterial supply
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Pancreas neck, body and tail
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Dorsal pancreatic artery (from splenic artery or coeliac trunk)
Pancreatica magna artery ( emerges halfway along the splenic artery)
Transverse pancreatic artery (travels along the length of the
pancreatic duct and anastomoses with the above arteries)
Pancreas head
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Superior pancreaticoduodenal artery
(anterior and posterior branches from
the gastroduodenal artery)
Inferior pancreaticoduodenal artery
(anterior and posterior branches from
the superior mesenteric artery)
Venous drainage
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SMV
Splenic vein
Portal vein
Lymphatic drainage
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Along arterial blood supply to pre-aortic coeliac lymph
nodes
Radiological anatomy
US
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3 - 7.5 MHz probe
Sagittal, transverse and oblique planes
Occasionally, may have non-visualization due to bowel
gas which can be overcome by:
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2.
3.
Fill stomach with fluid
Position patient erect (liver descends)
Prone position for tail
CT
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Similar density as
liver
Density is reduced
with increasing age
due to normal
accumulation of fat
Homogenous
enhancement post
contrast
MRI
ERCP
MRCP
References
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Imaging Anatomy of the Pancreas Referaat, Dr Frans Naude
Normal Findings in CT and MRI,Moeller
Pocket Atlas of Sectional Anatomy Computer Tomography and
Magnetic Resonance Imaging, Torsten B. Moeller, MD
Last’s anatomy 11th ed , Sinnatamby
Applied radiological anatomy , Butler
Atlas of human anatomy, F Netter
Pocket Atlas of Radiographic Anatomy,second edition,Moeller
Atlas of normal rontgen variants that may simulate disease, R
Keats
Color Atlas of Ultrasound Anatomy ,Berthold Block
Grant atlas of anatomy