Learning Objectives
To describe Contrast Enhanced Ultrasound (CEUS) findings that allow characterization of pancreatic tumours.

Imaging Findings
Ductal adenocarcinoma: poor enhancement appearing hypoechoic.
Mass-forming pancreatitis: parenchymographic enhancement.
Endocrine tumours: strong enhancement, appearing hyperechoic.
Pseudocyst: no intralesional enhancement.
Serous cystadenoma: enhancement of intralesional septa with microcystic feature.
Mucinous cystc neoplasms: ceus helps identify parietal nodules and septa, for the differential diagnosis with pseudocysts.
CEUS of the pancreas: why should we do it?
1. US if often the first examination performed in patients with suspicion of pancreatic pathology
2. the greater accuracy of CEUS compared to baseline US can immediately result in better diagnostic workup and treatment planning also in incidentally found pancreatic lesions
Teaching points
1: any focal pancreatic mass hypo-enhancing at CEUS should be considered a ductal adenocarcinoma until otherwise proven.
2: endocrine tumors are the first differential diagnosis for any focal pancreatic mass hyper-enhancing at CEUS.
3: the presence of vascularized inclusions in a cystic lesion at CEUS excludes the diagnosis of pseudocyst, and the diagnosis of cystic tumor must be considered.