US Abdomen with IV Contrast Contrast-enhanced US (CEUS) is emerging as a potential option for focal evaluation of the pancreas, and it is well suited to the evaluation of perfusion with its use of intravascular contrast agents [15]. However, the use of microbubble contrast for this indication is currently not approved by the FDA, and its use would be considered off-label. Additionally, in a majority of patients, the diagnosis of AP can be made based on the clinical findings of typical abdominal pain and elevated serum lipase or amylase levels to at least 3 times the upper limits of normal or greater. Therefore, CEUS may not provide additional information in patients with an unequivocal clinical presentation and appropriately elevated amylase and lipase. Similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. US Duplex Doppler Abdomen Adding spectral, color, and power Doppler US to traditional grayscale US adds hemodynamic information concerning vessel patency and flow direction and may be useful for differentiating vascular from nonvascular Acute Pancreatitis structures, particularly differentiating hepatic arteries and portal veins from bile ducts. Every patient presenting with AP and no obvious alternative etiology should undergo transabdominal US to assess for gallstones as the possible cause [12]. Spectral, color, and power Doppler should be used as necessary to differentiate vascular from nonvascular structures in this instance. However, beyond evaluating for gallstones in the large majority of patients, the diagnosis can be made based on typical clinical symptoms and laboratory findings of an amylase and/or lipase level elevated to 3 times the upper limit of normal, or greater, without additional cross-sectional imaging [1]. Variant 2: Suspected acute pancreatitis.
Acute Pancreatitis. US Abdomen with IV Contrast Contrast-enhanced US (CEUS) is emerging as a potential option for focal evaluation of the pancreas, and it is well suited to the evaluation of perfusion with its use of intravascular contrast agents [15]. However, the use of microbubble contrast for this indication is currently not approved by the FDA, and its use would be considered off-label. Additionally, in a majority of patients, the diagnosis of AP can be made based on the clinical findings of typical abdominal pain and elevated serum lipase or amylase levels to at least 3 times the upper limits of normal or greater. Therefore, CEUS may not provide additional information in patients with an unequivocal clinical presentation and appropriately elevated amylase and lipase. Similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. US Duplex Doppler Abdomen Adding spectral, color, and power Doppler US to traditional grayscale US adds hemodynamic information concerning vessel patency and flow direction and may be useful for differentiating vascular from nonvascular Acute Pancreatitis structures, particularly differentiating hepatic arteries and portal veins from bile ducts. Every patient presenting with AP and no obvious alternative etiology should undergo transabdominal US to assess for gallstones as the possible cause [12]. Spectral, color, and power Doppler should be used as necessary to differentiate vascular from nonvascular structures in this instance. However, beyond evaluating for gallstones in the large majority of patients, the diagnosis can be made based on typical clinical symptoms and laboratory findings of an amylase and/or lipase level elevated to 3 times the upper limit of normal, or greater, without additional cross-sectional imaging [1]. Variant 2: Suspected acute pancreatitis.