7 yr old child presented to USG with complaints of recurrent abdominal pain.

USG findings:-

Bulky heterogenous pancrease, pancreatic calcifications, dilated pancreatic duct s/o Chronic pancreatitis. Bo focal lesion noted.

No fluid collection seen.

No changes of acute pancreatitis noted.

Ultrasound (USG) Findings in Chronic Pancreatitis in Children

Chronic pancreatitis (CP) in children is less common than acute pancreatitis but can be caused by genetic mutations (e.g., PRSS1, CFTR, SPINK1), autoimmune diseases, metabolic disorders, or recurrent acute pancreatitis episodes.

Key USG Findings in Pediatric Chronic Pancreatitis

1. Pancreatic Atrophy – The pancreas may appear smaller due to progressive damage and fibrosis.
2. Heterogeneous Echotexture – The pancreatic tissue appears uneven due to fibrosis and inflammation.
3. Dilated Pancreatic Duct (>3 mm) – The main pancreatic duct may be widened due to obstruction or fibrosis.
4. Intraductal Calculi – Hyperechoic (bright) foci with posterior acoustic shadowing indicate pancreatic duct stones.
5. Irregular Pancreatic Borders – The normally smooth pancreatic outline may become irregular.
6. Peripancreatic Fat Infiltration – Increased echogenicity around the pancreas due to chronic inflammation.
7. Cystic Changes/Pseudocysts – Fluid-filled cystic areas may form due to prior episodes of inflammation.
8. Reduced Vascularity on Doppler – Decreased blood flow due to fibrosis and atrophy.

Limitations of USG in Chronic Pancreatitis

• Bowel Gas Interference – Overlying gas may obscure the pancreas.
• Mild CP May Not Show Significant Changes – Early cases might appear normal.
• Operator Dependency

Other Imaging-

• Magnetic Resonance Cholangiopancreatography (MRCP): Best for assessing ductal changes and structural abnormalities.
• CT Scan: Helpful for detecting calcifications and complications.
• Endoscopic Ultrasound (EUS): Provides high-resolution imaging for early-stage CP.