An 81 year old woman presented to the emergency room with one week history of abdominal pain and general weakness. The abdominal CT scan showed a 30mm mass in the body of the pancreas, suggestive of a neoplastic process, so the patient was scheduled for an EUS for local staging and tissue sampling . The endoscopic ultrasound confirmed a 26 mm mass in the neck of the pancreas, c uT2N0 (Fig. 1).
Fig. 1 – Pancreatic tumor.
On withdrawal, during the posterior mediastinum scanning, we identified a hypo-echoic mass that occupied almost 90% of the left pulmonary artery (Fig. 2). An angioCT scan later confirmed the pulmonary embolism and the patient was started on anticoagulation therapy.
Fig. 2 – Thrombus in left pulmonary artery (LPA)
As the number of EUS procedures increases, gastroenterologists will be expected to identify more incidental findings in structures beyond the GI tract that could have an impact on patient´s management and prognosis. Therefore, a methodic evaluation of all the surrounding systems, beyond the scope of the exam, is crucial.
Irina Mocanu1, Rita Barosa2, Marta Patita2, Gonçalo Nunes2, Pedro Pinto Marques2
1. Gastroenterology Department, Hospital Espírito Santo, Évora
2. Gastroenterology Department, Hospital Garcia de Orta, Almada.