Improved ultrasound imaging of the pancreas with the transsplenic view and THI

The conventional ultrasound examination of the pancreas from ventral is - especially concerning the leftsided parts of the organ - limited by interposition of stomach, flexura duodenojejunalis or colon. The transsplenic view to the cauda pancreatis is less known, but allows quite often a good possibility to examine this part of the retroperitoneal organ, even when examination from ventral is impossible. Aim: Comparison of ventral and transsplenic ultrasound examination - with and without tissue harmonic imaging (THI) - in regard to the diagnostic accessability to the cauda pancreatis. Method: Ultrasound examination of 135 patients from both positions with and without THI and comparison of the accessability by experienced examiners. Results: As examination from the ventral position allows a proper view to the cauda only in 58%, the transsplenic position allows an adequate view in 98%. The examiners regarded THI as a useful improvement in examining the pancreas in 85%. Conclusion: The transsplenic view to the pancreas is less known than the examination from the classical ventral transducer position. It enables the examinator quite often to examine the pancreatic cauda even when examination from ventral is impossible. Therefore it should be enclosed in the routine procedure of abdominal ultrasound examination. THI is a further possibility to improve the ultrasound access to the pancreas, especially when conditions for a good view and proper examination are limited.