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US Quiz January 2020

Case Report A 65-year old asymptomatic male was referred to our Gastroenterology Department following incidental detection on abdominal ultrasound of a pancreatic head tumour, strongly hypoechoic, with 35mm in diameter, just above the confluence of the superior mesenteric and splenic veins. Magnetic resonance cholangiography (MRI) suggested a solid lesion measuring 30mm adjacent to the splenic-mesenteric-portal venous confluence and above the pancreatic isthmus; an identic lesion measuring 16mm was detected adjacent to the pancreatic tail (Fig. 1. and 2.). Endoscopic ultrasonography (EUS) documented an anechoic structure with thin well-defined walls adjacent to the portal confluent and continuing with the splenic vein, 30mm in diameter, with positive colour Doppler and monophasic waveform in pulse wave Doppler study; this lesion was adjacent to the pancreas but with a clear interface with it (Fig. 3.). Adjacent to the pancreatic tail another lesion was identified, mildly hypoechoic, homogenous, well defined regular walls, 14mm in diameter, again with a clear interface with the pancreas and the spleen (Fig 4.).  Quiz Discussion A wide range of anatomic variants and pathologic conditions in and around the pancreas may simulate primary pancreatic neoplasia at different imaging modalities. Based on EUS appearance of the lesion and its relation to the splenic vein, the diagnosis of splenic vein aneurysm was easily made. The smaller lesion had very different US characteristics suggesting an accessory spleen, due to its location and US features (namely similar echostructure to the adjacent spleen). Venous system aneurysms are uncommon and splenic vein aneurysms are exceedingly rare. Lowenthal and Jacob described the first case of splenic vein aneurysm in […]


US Quiz September 2019

Case Report We present the case of a 71-year-old female patient with past medical history remarkable for a pancreatic head cystic lesion diagnosed in 2009. It was a 24mm multilocular cystic lesion with a central scar, that remained  asymptomatic and stable in size until 2015, when follow-up was lost. In 2019 the patient developed new onset jaundice, choluria and acolia. An abdominal ultrasound was performed and revealed a 47x45mm heterogeneous mass in the pancreatic head, associated with de-novo common bile duct dilatation (CBD, 17mm in the liver hilum) (Fig. 1). Figure 1. Abdominal ultrasound: heterogeneous pancreatic head mass. Magnetic resonance cholangiopancreatography (MRCP) showed a multilocular pancreatic head cystic lesion, measuring 60x70x57mm (Fig. 2) and apparently communicating with the main pancreatic duct (MPD). There was also CBD and intrahepatic bile duct dilation. Figure 2. MRCP: multilocular pancreatic head cystic lesion, apparently communicating with the MPD, and CBD and intrahepatic bile duct dilation. Endoscopic ultrasound (EUS) documented a predominantly microcystic lesion located in the head of the pancreas, measuring 53x46mm, with a few macrocysts and pseudo-solid areas, compressing the CBD and the superior mesenteric vein,  and without vascular invasion or Wirsung dilatation (Fig. 3). Fine needle aspiration (FNA) of the macrocyst and of a pseudo-solid area was performed. Cyst fluid biochemistry analysis revealed a high amilase level (54085 UI/L) and a normal CEA (2 ng/mL). Figure 3. EUS: predominantly microcystic pancreatic lesion located in the head of the pancreas, with a few macrocysts and pseudo solid areas.   Quiz   Discussion EUS-FNA cytology showed cuboidal cells, […]


GRUPUGE Prizes 2019

GRUPUGE Prizes at the Portuguese Digestive Week 2019: click here.