福岡徳洲会病院臨床検査科超音波検査部門Department of Ultrasound and Clinical Laboratory, Fukuoka Tokushukai Hospital
緒言：外傷精査において超音波検査（US）は最初に選択されることの多い画像検査であるが，USで膵尾部損傷の確定的所見を捉えた報告は確認できない．今回我々は，アプローチ法を工夫することによってUSが確定診断に寄与した外傷性膵尾部損傷の3例を報告する．
症例1：10歳未満男児．腹部打撲後に腹痛と吐血を認めた．USでは脾周囲に液体貯留を認めたが，脾損傷は認めなかった．右側臥位では，明瞭に膵尾部が描出され，膵損傷を疑うスリット状の低エコー域を認めた．
症例2：10歳未満女児．自転車転倒による腹部打撲後に腹痛と嘔吐が持続した．初回USでは損傷部位は指摘困難であったが，数時間後に右側臥位で再検査を行ったところ，膵尾部にスリット状の低エコー域と血腫を認めた．左腎を音響窓とすることで，損傷部位はより明瞭に描出された．
症例3：10代男児．失神後に腹部を打撲した疑いがあり，持続する心窩部痛を認めた．USでは右側臥位にて膵尾部にスリット状の低エコー域を認めた．
3例とも造影CTおよびMRIにて膵尾部損傷が確認された．
考察および結語：USは非侵襲的検査であり，外傷精査の第一選択として用いられるべき検査であるが，解剖学的理由から膵尾部の描出率は高くはない．本症例は，右側臥位への体位変換や音響窓として他臓器を利用することで，膵尾部の損傷部位の指摘を可能にした．膵実質内のスリット状低エコー域は膵実質の裂傷の可能性を疑う重要な所見である．
Background: Traumatic pancreatic injury is uncommon and often challenging to diagnose. Ultrasound (US) is typically the initial imaging modality in trauma evaluation; however, assessment of the pancreatic tail is frequently limited by overlying gastrointestinal gas. We present three pediatric cases in which US successfully detected traumatic pancreatic tail injury.
Case 1: A boy under 10 years old presented with abdominal pain and hematemesis following blunt abdominal trauma. US demonstrated perisplenic fluid without splenic injury. Improved visualization in the right lateral decubitus position revealed a slit-like hypoechoic lesion in the pancreatic tail.
Case 2: A girl under 10 years old sustained bicycle-related abdominal trauma and developed persistent abdominal pain with vomiting. The initial US was inconclusive, but repeat scanning in the right lateral decubitus position revealed a slit-like hypoechoic lesion in the pancreatic tail, accompanied by surrounding hematoma and pancreatic leakage. The lesion was more clearly defined when the kidney was used as an acoustic window.
Case 3: A teenage boy with a history of syncope and subsequent abdominal trauma presented with epigastric pain. US in the right lateral decubitus position revealed a slit-like hypoechoic lesion in the pancreatic tail. In all cases, pancreatic injury was later confirmed by contrast-enhanced CT (CECT) and MRI.
Discussion: Although CECT remains the gold standard for diagnosing pancreatic trauma, US is advantageous in pediatric patients due to the absence of radiation exposure. These cases emphasize the utility of positional adjustments—such as right lateral decubitus positioning and the use of adjacent organs as acoustic windows—to enhance visualization of the pancreatic tail. Identification of slit-like hypoechoic lesions is an important sonographic sign suggestive of pancreatic laceration.
Conclusion: We report three pediatric cases of traumatic pancreatic tail injury accurately diagnosed with US. Optimized scanning techniques, including right lateral decubitus positioning and strategic acoustic windowing, played a crucial role in improving diagnostic accuracy.
Key words: ultrasonography; pancreatic injuries; pancreatic tail; right lateral position; diagnosis
© 2025 一般社団法人日本超音波検査学会© 2025 Japanese Society of Sonographers
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