At present ultrasound (US) is performed as first choice exam in the diagnostic approach to the patient with suspected carcinoma of the pancreatic head area. The role of US is limited because of the difficult assessment of the infiltration of peripancreatic fat, of hollow viscera and of adjacent vascular structures. Lymph node invasion is better shown by CT than by US. A significant improvement in the diagnostic accuracy may be possible with the clinical application of the new US procedures as color-Doppler US, endoscopic US and laparoscopic US.