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Home , Linitis plastica

1 Acquiring and Improving Skills in Diagnostic Endosonography 1 1.1 Cognitive Biases 2 1.1.1 Confirmation Bias and Framing in Imaging 3 1.1.2 Tmage Perception Research and Field-Dependence Bias 5 1.2 Dealing with Artifacts 8 1.2.1 The Importance of Contrast Resolution in EUS 8 1.2.2 Streak Artifacts on CT Obscuring Important Pathology Discovered by EUS 12 1.2.3 The Limitations of CT Measurements (Hounsfield Units) 14 1.2.4 Reverberation Artifact 16 1.2.5 Partial Volume Artifact 18 1.3 Anatomic Landmarks 22 1.3.1 Thyroid 22 1.3.2 Esophagus and Mediastinum 24 1.3.3 Abdomen 34 1.4 Doppler Endosonography 40 1.4.1 Mediastinum 40 1.4.2 Upper Abdomen 42 1.4.3 Pelvis 54 1.5 Medical Image Retrieval and Decision Support Systems 55 1.5.1 General Image Retrieval Platforms 55 1.5.2 Radiology Centric Image Retrieval 58 1.6 Textbooks and Journals 59 1.7 Integrating Genomics into Your EUS Practice with FNA .... 60 1.7.1 The Problem of Pancreatic : Could Micro RNAs Be the Answer? 60 1.7.2 Personalized Tumor Therapy: Lung Now and in the Future 62 1.7.3 The Primacy of FNA Cytology in the Management of Pancreatic 63 1.7.4 Stroma and Tumor Cells: The Need for Specimen Enrichment and How FNA Can Do It 63 1.7.5 Specimen Handling: Know What Needs to Happen with Your Specimen 65

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1.7.6 How to Participate in Translational Research Involving Cancer Molecular Pathology .... 66 1.8 Solution to Challenge Case 66 References 66

2 Esophagus and Mediastinum 71 2.1 General Principles 71 2.1.1 The Esophagus: A Window into the Mediastinum. .. . 71 2.1.2 The Esophagus Is Not a Pipe 72 2.1.3 Endobronchial Ultrasound 72 2.1.4 Lymph Node Maps for the Mediastinum 73 2.1.5 Mediastinal Biopsies 73 2.1.6 Examination of the Esophagus 73 2.2 Cases and Discussions 74 2.2.1 Mediastinum 74 2.2.2 Esophagus 125 References 145

3 147 3.1 General Principles 147 3.1.1 Anatomy 147 3.1.2 EUS Probes 148 3.1.3 Technique 148 3.1.4 Preparation 149 3.2 Cases and Discussions 150 3.2.1 Gastric Cancer 150 3.2.2 Linitis Plastica of the Stomach 154 3.2.3 Linitis Plastica with Bone Metastases 156 3.2.4 Stage 1 Mucosa-Associated Lymphoid Tissue Lymphoma 159 3.2.5 MALT Lymphoma with Local and Distant Lymph Node Involvement 162 3.2.6 Subepithelial Gastric Tumors 166 3.2.7 Gastrointestinal Stromal Tumor with Central Ulceration 167 3.2.8 Metastatic Gastrointestinal Stromal Tumor 170 3.2.9 Gastrointestinal Stromal Tumors and Interstitial Cells of Cajal 172 3.2.10 An Unusual Gastrointestinal Stromal Tumor in a Patient with Situs Inversus 174 3.2.11 Gastrointestinal Stromal Tumors: Principles of Biopsy 177 3.2.12 Gastric 179 3.2.13 Gastric Lipoma 182 3.2.14 Thickened Gastric Folds, Gastric Varix, or Subepithelial Lesion? 184 3.2.15 Pancreatic Rest 188 3.2.16 Submucosal Gastric Pseudotumor 191 3.2.17 Perigastric Abscess 193 References 195 xi

4 Duodenum 197 4.1 General Principles 197 4.1.1 Anatomy 197 4.1.2 EUS Probes 197 4.1.3 Technique 197 4.2 Cases and Discussions 198 4.2.1 198 4.2.2 Duodenal Diverticulum 201 4.2.3 Duodenal Perforation by Foreign Body 203 4.2.4 Duodenal Pseudocyst 207 4.2.5 Ampullary 211 4.2.6 Familial Adenomatous Polyposis 213 4.2.7 Periduodenal Collaterals 215 4.2.8 Primary Duodenal Non-Hodgkin's Lymphoma 218 4.2.9 Transduodenal Abscess Drainage 222 4.2.10 Zollinger-Ellison Syndrome: An Imaging Odyssey . . . 230 References 233

5 , Liver, and Bile Ducts 235 5.1 General Principles 235 5.2 Cases and Discussions 237 5.2.1 Gallbladder 237 5.2.2 Liver 248 5.2.3 Bile Ducts 265 References 296

6 297 6.1 General Principles 298 6.1.1 Technique 298 6.1.2 Endoscopic Ultrasound Probes 298 6.1.3 Anatomic Considerations 298 6.2 Cases and Discussions 301 6.2.1 Acute Pancreatitis with an Edematous Pancreatic Head 301 6.2.2 Chronic Pancreatitis 306 6.2.3 Pancreatic Parenchymal Calcifications and Stone in the Pancreatic Duct 308 6.2.4 Fatty Infiltration of the Pancreas 311 6.2.5 Perivascular Fat Mimicking a Dilated Main Pancreatic Duct 314 6.2.6 Vanishing Pancreatic Mass 317 6.2.7 Pancreatic Cancer 320 6.2.8 T2 of the Pancreas 323 6.2.9 Pancreatic Tail Mass 326 6.2.10 Calcifications in a Hypoechoic Pancreas Tumor 328 6.2.11 Chronic Pancreatitis and Pancreatic Cancer 329 6.2.12 Small Pancreatic Cancer 332 6.2.13 Isodense Pancreatic Cancer 334 6.2.14 Large Pancreatic Head in Relation to Body 338 6.2.15 Gardner's Syndrome and Pancreatic Cancer 341 xii

6.2.16 Missed Pancreatic Cancer 344 6.2.17 Ovarian Cancer Metastatic to the Pancreas? 348 6.2.18 Characteristic Appearance of a Wallstent on EUS .... 351 6.2.19 FNA Biopsies Through a Wallstent 354 6.2.20 Neuroendocrine Tumors 355 6.2.21 Primary Pancreatic Lymphoma 361 6.2.22 Mycosis Fungoides Infiltrating the Pancreas 364 6.2.23 Pancreatic Cysts 367 6.2.24 Serous 379 References 381

7 Adrenals and Spleen, , and Retroperitoneum 385 7.1 General Principles 385 7.1.1 Anatomy and Technique 385 7.2 Cases and Discussions 386 7.2.1 Adrenal Biopsy 386 7.2.2 Myelolipoma Inside an Adrenal 390 7.2.3 Paraganglioma 392 7.2.4 Accessory Spleen 394 7.2.5 Ascites 396 7.2.6 Omentum 398 7.2.7 Fluid in the Lesser Sac 400 7.2.8 Mesenteric Cysts 402 7.2.9 Omental Cake 405 7.2.10 Peritoneal Carcinomatosis 409 7.2.11 Retroperitoneal Carcinomatosis 411 References 414

8 Colon, Rectum, and Anus 415 8.1 General Principles 415 8.1.1 Anatomy of the Rectal Wall and Perirectal Structures: Correlation with EUS 415 8.1.2 Endoscopic Ultrasound Probes 419 8.1.3 Preparation 419 8.1.4 Endoscopic Ultrasound Examination Technique 419 8.2 Cases and Discussions 421 8.2.1 Progression of Rectal Cancer from T2N0 to T3N1 ... 421 8.2.2 T3N1 Rectal Carcinoma: Response to Treatment .... 425 8.2.3 Colon Cancer Metastatic to Mediastinal Lymph Nodes 428 8.2.4 Large Colon Polyp 431 8.2.5 Large Villous Adenoma with High-Grade Dysplasia. . 433 8.2.6 with Extensive Intramural Spread into the Rectum 435 8.2.7 Anorectal Melanoma 438 8.2.8 Diffuse Cavernous Rectal Hemangioma 442 8.2.9 Cystic Lymphangioma of the Colon 445 8.2.10 Coccygeal Chordoma 449 References 452

Index 455