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US Quiz April 2019

Case Report A 79-year-old woman, with no relevant past medical history was admitted due to an idiopathic acute pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) revealed a focal main pancreatic duct (MPD) stricture in the pancreatic head with moderate upstream dilatation (7 mm), as well as prominence of secondary branches. In the uncinate process, a 17 mm cystic lesion with no apparent communication with the MPD was also described. This acute episode had a good clinical course and the patient was discharged. One month later, she underwent another MRCP that showed no evidence of the aforementioned stricture but pointed a 9 mm dilatation of the MPD at the level of the pancreatic head. Serum CA 19.9 and CEA were normal. Four months later, she was admitted due to a new episode of mild acute pancreatitis. At that time, she was referred to our institution for endoscopic ultrasonography (EUS). This exam revealed a lesion in the pancreatic head along with an atrophic pancreatic parenchyma, with lobularity, hyperechoic foci and stranding. Elastography and contrast-enhanced harmonic EUS (SonoVue®) were performed. EUS revealed in the pancreatic head a cystic dilatation of the MPD (15×15 mm), with a hyperechogenic solid component and digitiform projections that conditioned almost complete occlusion of the duct (Figure 1). Figure 1. EUS: cystic dilatation of the MPD (15×15 mm) in the pancreatic head, with a hyperechogenic solid component and digitiform projections that conditioned almost complete occlusion of the duct. The solid component had a “hard” pattern on elastography (strain ration 18.79; Figure 2) and revealed an heterogenous […]

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Ultrasound Imaging Prize – Submit your Image/Video!

Ultrasound Imaging Prize Deadline: April 30 2021

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US Quiz March 2019

Case Report A 65-year-old woman presented with new onset diabetes. Hes past medical history was remarkable for headache, anxiety and vasomotor symptoms for the last 3 years. Abdominal ultrasound followed by contrast-enhanced abdominal computed tomography (CT) revealed a 14-cm enhanced heterogeneous intra-abdominal mass, with cystic areas, in contact with the posterior wall of the gastric fundus (Figure 1).  Figure 1. Abdominopelvic CT (axial and coronal view): a 14-cm enhanced heterogeneous intra-abdominal mass, with cystic areas, in contact with the posterior wall of the gastric fundus. Endoscopic ultrasound (EUS) was performed and showed a giant well-defined rounded hypoechogenic mass, without cleavage plane between the mass and the gastric wall. This was a very heterogeneous mass, with anechoic areas, suggestive of cystic transformation. Its size exceeded the endoscopic field (Figure 2-4). Figure 2. EUS (transgastric view): a giant well-defined rounded hypoechogenic and heterogeneous mass, with anechoic areas, suggestive of cystic transformation.   Quiz   Discussion EUS-fine needle biopsy (EUS-FNB) using a 25G needle with rapid on site cytological examination (ROSE) was performed. Cytological analysis  performed on the cell block demonstrated irregular clusters of  cells with finely eosinophilic granular cytoplasm and pronounced anisokaryosis with large and irregular nuclei (Figure 5). Immunohistochemistry was positive for vimentin and synaptophysin and negative for CD117, S100 and CD34; Ki67<3%. Figure 5. Cithology (Papanicolaou, 100x): irregular clusters of  cells with finely eosinophilic granular cytoplasm and pronounced anisokaryosis with large and irregular nuclei. Toward these findings, 24-hour urine fractionated metanephrines were measured and were elevated (normetanephrine 5832pg/mL and metanephrine 11738pg/mL) and […]

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