Clinical presentation:
40 year old man with recurrent abdominal pain after previous acute pancreatitis.

• Features in images
• Diagnosis
• Differential Similar appearances to this image.

Features in the image

The pancreas can be recognised by the usual comma shape, which is draped over the spine and abdominal aorta, like one of Salvador Dali's clocks. In this image, the appearance is distorted by numerous echogenic foci with accoustic shadowing. In less ideal circumstances these might be confused with obscuring bowel gas. Here the intra pancreatic site can be identified. Note the irregular and dilated pancreatic duct which is visible in the body of the pancreas in the lower of the two images.

existing cases of other pathology that may resemble primary pathology

Retroperitoneal gas
Pancreatic carcinoma