Last Quiz

US Quiz September 2018

Case Report An 81 year-old anticoagulated male patient, with a medical history of atrial fibrillation and valvular cardiomyopathy, performed a total colonoscopy due to intermittent hematochezia, which revealed in the distal rectum a well-defined and regular protruded sessile lesion with 16 mm (T0 Is) (Figure 1). Figure 1. Protruded sessile lesion (T0 Is) with 16 mm, in the distal rectum. Endoscopic ultrasound examination (EUS) identified a hypoechoic lesion with clear margins arising from the second layer, without lymph node or muscular layer involvement (Figure 2). Figure 2. Hypoechoic lesion arising from the second layer.   Quiz   Discussion Abdomino-pelvic computerized tomography (CT) and PET-TC DOTA NOC showed no distant metastasis. Multidisciplinary evaluation was carried out and excision of the tumor by endoscopic submucosal dissection (ESD) was planned. The procedure was performed with no complications reported (Figure 3). Figure 3. A to F – Endoscopic excision of a rectal neuroendocrine tumor by endoscopic submucosal dissection (circumferential mucosal cutting and submucosal dissection performed with the Dual-Knife, Olympus®). Pathological analysis confirmed the diagnosis of a totally resected well differentiated neuroendocrine tumor (G1) with a low mitotic index (Ki67 < 2%) and no lymphovascular invasion. No distant metastasis were identified during the follow up period (2 years). The incidence of rectal neuroendocrine tumors has been rising largely due to an increased number of screening colonoscopies, allowing for identification of smaller lesions amenable to endoscopic treatment1. Indeed, endoscopic therapy of neuroendocrine tumours may be considered in lesions below 2 cm, without muscularis invasion according to the European Neuroendocrine […]


US Quiz August 2018

Case Report A 70-years-old man presented with weight loss. He reported heavy smoking and consumption of 2 units of alcohol per day. A thoracic and abdominal computed tomography was performed and revealed cephalic pancreatic enlargement with multiple calcifications scattered throughout the pancreas, a hypodense mass in the uncinated process and irregularly dilated main pancreatic duct. Endoscopic ultrasound showed multiple diffuse infracentimetric pancreatic cysts, most of which with small foci of mural calcification, communicating with the main pancreatic duct, two larger cysts with 20mm and 19mm in the head and uncinated process, respectively, with calcifiedmural nodules, and main pancreatic duct dilatation in the cephalic pancreas (max 4.6mm) (Figure 1) Figure 1 – EUS showed multiple diffuse infracentimetric pancreatic cysts communicating with the main pancreatic duct, with small foci of mural calcification. Quiz   Discussion Endoscopic ultrasound-guided fine-needle-aspiration using a 22Gneedle of the largest cyst was performed with drainage of viscous fluid positive for mucin stain. Cytology was negative for malignancy and cyst fluid analysis revealed elevated amylase and CEA, consistent with multifocal branch-duct intraductal papillary mucinous neoplasms (IPMN) with psammomatouscalcifications. Although relatively rare, cystic lesions of the pancreas are considered to be an increasingly important category with a spectrum of histology and malignant potential1. IPMN are detected with increasing frequency as more patients are exposed to radiologic imaging modalities2. Calcifications within IPMN have been reported, with a frequency ranging from 10% to 25%, however its significance is still unknown2. They are usually focal and peripheral3.Punctate calcification have been seen in approximately […]


US Quiz July 2018

Case Report


US Quiz of the Month

Instructions for Authors

US Quiz of the Month presents one or more striking ultrasound images in Gastroenterology that are meant to be a didactic challenge to readers. The clinical case is presented as unknown, with the diagnosis hinging on the correct interpretation and integration of the image and clinical data. Each month a new case is presented.
Manuscript must be sent as a Microsoft Word document to and must follow the instructions below:

Title: title cannot reveal diagnosis.
Authors: maximum 5 authors. provide authors’ name and filiation.
Structure: Case description; Multiple choice question (5 choices); Discussion; References.
Word Count: maximum 600 words, excluding figure and video legends and references.
Figures/Videos: maximum 4 images and/or 1 video. Figure and video legends are required. Figures must be submitted as separate attachments in JPEG or TIFF formats (minimum 150 PPI resolution) and videos must be submitted as separate attachments in MOV or MO4 formats.
References: maximum 6 references. References should be cited according to the Vancouver reference style.




Prémio Melhor “US Quiz of the Month


O Prémio “Melhor US Quiz of the Month”, da responsabilidade do GRUPUGE, destina-se a premiar o melhor US Quiz of the Month publicado, em cada ano, no site oficial do GRUPUGE (


Ao vencedor do prémio “Melhor US Quiz of the Month” será oferecida uma inscrição num congresso internacional de ecoendoscopia, designadamente no EURO EUS.


O Prémio “Melhor US Quiz of the Month” será entregue no decurso da Semana Digestiva de cada ano.


Serão candidatos ao Prémio “Melhor US Quiz of the Month”, os 12 US Quiz of the Month aceites para publicação no site do GRUPUGE nos meses de Maio do corrente ano a Abril do ano seguinte.


Os critérios a serem avaliados pelo júri incluem:
a) Originalidade;
b) Relevância Clínica;
c) Rigor Científico;
d) Qualidade Iconográfica.

Cada um dos critérios será classificado de 0-5 pontos, completando um total de 20 pontos


O Júri, formado por 4 elementos, é nomeado anualmente pela Direcção do GRUPUGE.


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