Z Gastroenterol 2019; 57(05): e142-e143
DOI: 10.1055/s-0039-1691885
POSTER
Endoskopie
Georg Thieme Verlag KG Stuttgart · New York

How endoscopic ultrasound (eus) was decisive to establish the correct diagnosis of patients – a case series

M Razpotnik
1   Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
,
S Bota
1   Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
,
G Essler
1   Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
,
J Weber-Eibel
1   Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
,
M Peck-Radosavljevic
1   Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

Also available at
 

Aim:

To present how EUS was decisive to establish the correct diagnosis in a series of patients.

Methods:

Cases, where EUS establish the correct diagnosis despite inconclusive radiologic evaluation, were identified in our EUS database.

Results:

Case 1-74 year old female patient, hospitalized due to acute pancreatitis of unknown etiology. CT Scan showed a normal pancreas. EUS excluded a biliary etiology, but a 1.7 × 1.5 cm hypoechoic mass in the head of the pancreas was identified. MRI performed could not cleary detect the lesion. EUS-FNA showed atypical cells with high grade dysplasia. Surgery was performed and histology showed pancreatic adenocarcinoma.

Case 2-50 year old male patient, hospitalized because of deep vein thrombosis and pulmonary embolism. The patient had cachexia, mild ascites, and chronic alcohol consumption. The patient had no abdominal pain, lipase was normal and malignancy was suspected. CT Scan raised the suspicion of a liver metastasis and a suspect pancreatic lesion. MRI showed no evidence of a liver or solid pancreatic mass, only a pancreatic cyst. Diagnostic paracentesis did not detected tumor cells. EUS showed a 2.2 × 1.8 cm cystic lesion in pancreas with a 8 mm solid content. Fluid analysis obtained was typical for a pseudocyst. Paracentesis was again performed and showed increased lipase content. Secretin MRI was performed for suspicion of pancreatic duct fistula. This was confirmed and successfully treated by ERCP.

Case 3-56 year old female patient with known autoimmune thyroiditis hospitalized because of abdominal pain, weight loss and slightly increased lipase values. MRI raised the suspicion of a pancreatic mass and enlarged lymph nodes. EUS suspected an autoimmune pancreatitis. Fibrotic changes with lymphocyte infiltrate were presented in the histology obtained through EUS-FNA (IgG4 not elevated). Therapy with steroids was started and after 3 months MRI was normal and the patient was free of symptoms.

Conclusion:

EUS is a useful technique in clinical practice to establish a correct diagnosis in cases where radiology is inconclusive.