By Frank G Gress; et al
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10). A stack sign can be demonstrated in >80% of patients with normal pancreatic ductal anatomy. When pancreas divisum exists (3–7% of normal people), a stack sign can only be demonstrated in about one third of patients. Instead of not seeing a stack sign, in pancreas divisum may see the more specific crossed duct sign. The crossed duct sign results from the CBD being seen in cross section while the pancreatic duct, draining to the minor ampulla, is seen in longitudinal section. Atlas of Endoscopic Ultrasonography, First Edition.
The bile duct can then be followed towards the liver with continued slow withdrawal of the scope and slight right and left torque. 1). Combining views from both the stations, that is the duodenal bulb and the second portion of the duodenum, the entire biliary tree can be visualized. 6 Bile duct and pancreatic duct from the second portion of the duodenum (linear echoendoscope). 1 Radial and linear array images of the bile duct from the duodenum. 23 6 EUS of the Normal Pancreas Richard A. Erickson and James T.
1). The aorta, with a dark hypoechoic band which is the diaphragmatic crux, is seen immediately adjacent to the probe. In this position, near the hiatus, the hepatic veins are seen as anechoic structures, entering the inferior vena cava (IVC). In this position, possibly with left tip deflection, the spleen can be seen on the right of the screen. As the aorta is traced distally, maintaining its 6 o’clock position, the liver may still be seen anteriorly. Vascular structures can be differentiated from ductal structures by a thicker (echogenic) wall and the presence of flow.