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Pediatric Radiology

, Volume 35, Issue 4, pp 358–373 | Cite as

Disorders of the pediatric pancreas: imaging features

  • Els Nijs
  • Michael J. CallahanEmail author
  • George A. Taylor
Review

Abstract

The purpose of this manuscript is to provide an overview of the normal development of the pancreas as well as pancreatic pathology in children. Diagnostic imaging plays a major role in the evaluation of the pancreas in infants and children. Familiarity with the range of normal appearance and the diseases that commonly affect this gland is important for the accurate and timely diagnosis of pancreatic disorders in the pediatric population. Normal embryology is discussed, as are the most common congenital anomalies that occur as a result of aberrant development during embryology. These include pancreas divisum, annular pancreas, agenesis of the dorsal pancreatic anlagen and ectopic pancreatic tissue. Syndromes that can manifest pancreatic pathology include: Beckwith Wiedemann syndrome, von Hippel–Lindau disease and autosomal dominant polycystic kidney disease. Children and adults with cystic fibrosis and Shwachman–Diamond syndrome frequently present with pancreatic insufficiency. Trauma is the most common cause of pancreatitis in children. In younger children, unexplained pancreatic injury must always alert the radiologist to potential child abuse. Pancreatic pseudocysts are a complication of trauma, but can also be seen in the setting of acute or chronic pancreatitis from other causes. Primary pancreatic neoplasms are rare in children and are divided into exocrine tumors such as pancreatoblastoma and adenocarcinoma and into endocrine or islet cell tumors. Islet cell tumors are classified as functioning (insulinoma, gastrinoma, VIPoma and glucagonoma) and nonfunctioning tumors. Solid-cystic papillary tumor is probably the most common pancreatic tumor in Asian children. Although quite rare, secondary tumors of the pancreas can be associated with certain primary malignancies.

Keywords

Pediatric population Pancreas US CT MR 

References

  1. 1.
    Shirkhoda A, Gore R (2000) Anomalies and anatomic variants of the pancreas. In: Gore R, Levin M (eds) Textbook of gastrointestinal radiology. Saunders, Philadelphia, pp 1754–1766Google Scholar
  2. 2.
    Siegel MJ (1999) Adrenal glands, pancreas, and other retroperitoneal structures. In: Siegel MJ (ed) Pediatric body CT. Lippincott Williams and Wilkins, Philadelphia, pp 253–286Google Scholar
  3. 3.
    Berrocal T, Prieto C, Pastor I, et al (1995) Sonography of pancreatic disease in infants and children. Radiographics 15:301–313PubMedGoogle Scholar
  4. 4.
    Vaughn DD, Jabra AA, Fishman EK (1998) Pancreatic disease in children and young adults: evaluation with CT. Radiographics 18:1171–1187PubMedGoogle Scholar
  5. 5.
    Keats TE, Sistrom C (2001) Gastrointestinal system. In: Keats T, Sistrom C (eds) Atlas of radiologic measurement. Mosby, Philadelphia, pp 397–460Google Scholar
  6. 6.
    Chao HC, Lin SJ, Kong MS, et al (2000) Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis. J Ultrasound Med 19:757–763PubMedGoogle Scholar
  7. 7.
    Enriquez GE, Vazquez E, Aso C (1998) Pediatric pancreas: an overview. Eur Radiol 8:1236–1244CrossRefPubMedGoogle Scholar
  8. 8.
    Siegel MJ, Martin KW, Worthington JL (1987) Normal and abnormal pancreas in children: US studies. Radiol 165:15–18Google Scholar
  9. 9.
    Heuck A, Maubach PA, Reiser M, et al (1987) Age-related morphology of the normal pancreas on computed tomography. Gastrointest Radiol 12:18–22PubMedGoogle Scholar
  10. 10.
    Glaser J, Hogemann B, Krummenerl T, et al (1987) Sonographic imaging of the pancreatic duct. New diagnostic possibilities using secretion stimulation. Dig Dis Sci 32:1075–1081PubMedGoogle Scholar
  11. 11.
    Walsh E, Cramer B, Pushpanathan C (1990) Pancreatic echogenicity in premature and newborn infants. Pediatr Radiol 20:323–325PubMedGoogle Scholar
  12. 12.
    Scafidi DE, Young LW (2000) Diseases of the pediatric pancreas. In: Gore R, Levine M (eds) Textbook of gastrointestinal radiology. Saunders, Philadelphia, pp 2162–2172Google Scholar
  13. 13.
    Arcement CM, Meza MP, Arumanla S, et al (2001) MRCP in the evaluation of pancreaticobiliary disease in children. Pediatr Radiol 31:92–97CrossRefPubMedGoogle Scholar
  14. 14.
    Siegel MJ (2002) Adrenal glands, pancreas, and other retroperitoneal structures. In: Siegel M (ed) Pediatric sonography. Lippincott Williams and Wilkins, Philadelphia, pp 475–527Google Scholar
  15. 15.
    Skandalakis JE (1994) The pancreas. In: Skandalakis J, Gray S (eds) Embryology for surgeons. Williams and Wilkins, Baltimore, pp 366–404Google Scholar
  16. 16.
    Herman TE, Siegel MJ (1991) CT of the pancreas in children. AJR 157:375–379PubMedGoogle Scholar
  17. 17.
    Herman TE, Siegel MJ (1991) Polysplenia syndrome with congenital short pancreas. AJR 156:799–800PubMedGoogle Scholar
  18. 18.
    Prasad TR, Gupta SD, Bhatnagar V (2001) Ectopic pancreas associated with a choledochal cyst and extrahepatic biliary atresia. Pediatr Surg Int 17:552–4CrossRefPubMedGoogle Scholar
  19. 19.
    Andronikou S, Sinclair-Smith C, Millar AJ (2002) An enteric duplication cyst of the pancreas causing abdominal pain and pancreatitis in a child. Pediatr Surg Int 18:190–192CrossRefPubMedGoogle Scholar
  20. 20.
    Bethel CA, Luquette MH, Besner GE (1998) Cystic degeneration of heterotopic pancreas. Pediatr Surg Int 13:428–30CrossRefPubMedGoogle Scholar
  21. 21.
    Fremond B, Poulain P, Odent S, et al (1997) Prenatal detection of a congenital pancreatic cyst and Beckwith-Wiedemann syndrome. Prenatal Diagn 17:276–280CrossRefGoogle Scholar
  22. 22.
    Sirinelli D, Silberman B, Bauden JJ, et al (1989) Beckwith-Wiedemann syndrome and neural crest tumors: a report of two cases. Pediatr Radiol 19:242–245PubMedGoogle Scholar
  23. 23.
    Johnson PR, Spitz L (2000) Cysts and tumors of the pancreas. Semin Pediatr Surg 9:209–15CrossRefPubMedGoogle Scholar
  24. 24.
    Auringer ST, Ulmer JL, Sumner TE, et al (1993) Congenital cyst of the pancreas. J Pediatr Surg 28:1570–71CrossRefPubMedGoogle Scholar
  25. 25.
    Fill WL, Lamiell JM, Polk NO (1979) The radiographic manifestations of von Hippel-Lindau disease. Radiology 133:289–295PubMedGoogle Scholar
  26. 26.
    Levine E, Collins DL, Horton WA, et al (1982) CT screening of the abdomen in von Hippel-Lindau disease. AJR 139:505–510PubMedGoogle Scholar
  27. 27.
    Hough DM, Stephens DH, Johnson CD, et al (1994) Pancreatic lesions in von Hippel-Lindau disease: prevalence, clinical significance, and CT findings. AJR 162:1091–1094PubMedGoogle Scholar
  28. 28.
    Ros PR, Hamrick-Turner JE, Chiechi MV, et al (1992) Cystic masses of the pancreas. Radiographics 12:673–86PubMedGoogle Scholar
  29. 29.
    Ferrozzi Bova D, Campodonico F, et al (1996) Cystic fibrosis: MR assessment of pancreatic damage. Radiology 198:875–879PubMedGoogle Scholar
  30. 30.
    Daneman A, Gaskin K, Martin DJ, et al (1983) Pancreatic changes in cystic fibrosis: CT and sonographic appearances. AJR 141:653–655PubMedGoogle Scholar
  31. 31.
    Monti, Salerno T, Lucidi V, et al (2001) Pancreatic cystosis in cystic fibrosis: case report. Abdom Imaging 26:648–650CrossRefPubMedGoogle Scholar
  32. 32.
    Hernanz-Schulman M, Teele RL, Perez-Atayde A, et al (1986) Pancreatic cystosis in cystic fibrosis. Radiology 158:629–631PubMedGoogle Scholar
  33. 33.
    Lacaille F, Mani TM, Brunelle F, et al (1996) Magnetic resonance imaging for diagnosis of Schwachman’s syndrome. J Pediatr Gastroenterol Nutr 23:599–603CrossRefPubMedGoogle Scholar
  34. 34.
    Robberecht E, Nachtegaele P, VanRattinghe R, et al (1985) Pancreatic lipomatosis in the Shwachman-Diamond syndrome: identification by sonography and CT scan. Pediatr Radiol 348–349Google Scholar
  35. 35.
    Bom EP, Van derSande FM, Tjon RT, et al (1993) Shwachman syndrome: CT and MR diagnosis. J Comput Assist Tomogr 17:474–476PubMedGoogle Scholar
  36. 36.
    Berrocal T, Simon MJ, al-Assir I, et al (1995) Shwachman-Diamond syndrome: clinical, radiological and sonographic findings. Pediatr Radiol 25:356–359PubMedGoogle Scholar
  37. 37.
    Parker BR (2004) The pancreas. In: Kuhn JP, Slovis TL, Haller JO (eds) Caffey’s pediatric diagnostic imaging. Mosby, Philadelphia, pp 1527–1538Google Scholar
  38. 38.
    King L, Siegel MJ, Balfe DM (1995) Acute pancreatitis in children: CT findings of intra- and extrapancreatic fluid collections. Radiology 195:196–200PubMedGoogle Scholar
  39. 39.
    Jackson WD (2001) Pancreatitis: etiology, diagnosis, and management. Curr Opin Pediatr 13:447–451CrossRefPubMedGoogle Scholar
  40. 40.
    Jeffrey RB Jr, Federle MP, Crass RA (1983) Computed tomography of pancreatic trauma. Radiology 147:491–494PubMedGoogle Scholar
  41. 41.
    Buonomo C, Taylor GA, Share JC, et al (1998) Gastrointestinal tract. In: Kirks D, Griscom NT (eds) Practical pediatric imaging: diagnostic radiology of infants and children. Lippincott-Raven, Philadelphia, pp 821–1007Google Scholar
  42. 42.
    Taylor GA, Fallat ME, Eichelberger MR (1987) Hypovolemic shock in children: abdominal CT manifestations. Radiology 164:479–491PubMedGoogle Scholar
  43. 43.
    Lee JY, Kim IO, Kim WS, et al (1996) CT and US findings of pancreatoblastoma. J Comput Assist Tomogr 20:370–374CrossRefPubMedGoogle Scholar
  44. 44.
    Roebuck DJ, Yuen MK, Wong YC, et al (2001) Imaging features of pancreatoblastoma. Pediatr Radiol 31:501–506CrossRefPubMedGoogle Scholar
  45. 45.
    Montemarano H, Lonergan GJ, Bulas DI, et al (2000) Pancreatoblastoma: imaging findings in 10 patients and review of the literature. Radiology 214:476–482PubMedGoogle Scholar
  46. 46.
    Chezmar J (2000) Pancreatic neoplasms. In: Gore R, Levine M (eds) Textbook of gastrointestinal radiology. Saunders, Philadelphia, pp 1796–1811Google Scholar
  47. 47.
    Zhou H, Cheng W, Lam KY, et al (2001) Solid-cystic papillary tumor of the pancreas in children. Pediatr Surg Int 17:614–620CrossRefPubMedGoogle Scholar
  48. 48.
    Friedman AC, Lichtenstein JE, Fishman EK, et al (1985) Solid and papillary epithelial neoplasm of the pancreas. Radiology 154:333–337PubMedGoogle Scholar
  49. 49.
    Choi BI, Kim KW, Han MC, et al (1988) Solid and papillary epithelial neoplasms of the pancreas: CT findings. Radiology 166:413–416PubMedGoogle Scholar
  50. 50.
    Horisawa M, Niinomi N, Sato T, et al (1995) Frantz’s tumour (solid and cystic tumour of the pancreas) with liver metastasis: successful treatment and long term follow-up. J Pediatr Surg 30:724–726CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Els Nijs
    • 1
  • Michael J. Callahan
    • 2
    Email author
  • George A. Taylor
    • 2
  1. 1.Department of RadiologyUniversity Hospital Gasthuisberg3000 LeuvenBelgium
  2. 2.Department of RadiologyBoston Children’s HospitalBostonUSA

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