PMC3920997_01
Incidental endoscopic ultrasound finding of a 17 mm multi-locular cystic lesion of the thyroid. The endoscope is advanced by 18-20 cm and is orientated towards the anterior wall of the oesophagus.
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In addition, examination of the thyroid gland disclosed numerous thyroid nodules as well as a 17 mm multilocular cyst (Figure 1).
PMC3920997_02
(a) Linear endoscopic ultrasound view of a large pleural effusion (p) surrounding an area with tissue-like pattern resembling that of liver (asterisk). The endoscope is positioned at the upper oesophagus and orientated towards the right lateral wall (clockwise direction). (b) Computer tomography image of the same anatomical region showing an atelectatic superior upper lobe surrounded by the pleural effusion.
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EUS examination through the upper oesophagus disclosed a pleural effusion surrounding an area of tissue-like pattern corresponding to the upper superior lobe of the right lung (Figure 2).
PMC3920997_03
(a) Hypoechoic lesion of the superior left lobe (arrowheads) in close contact with the left subclavian artery (c). The endoscope is advanced at the level of the aortic arch and then rotated towards the left lateral wall of the oesophagus (counterclockwise direction). (b) Computer tomography image of the same lesion.
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A 60-year-old patient with a history of chronic obstructive pulmonary disease was referred for FNA of a para-oesophageal pulmonary nodule of the superior left lobe (Figure 3).
PMC3920997_04
Endoscopic ultrasound image of a heterogeneous hypoechoic intraluminal lesion of the right pulmonary artery (arrowhead). The endoscope is advanced at the mid-oesophagus and orientated towards the anterior and right lateral wall of the oesophagus. Computer tomography scan showed an invasion of the right pulmonary artery (p) by the tumour (arrowhead).
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EUS exam was performed in order to rule out a biliary origin. Examination of the mediastinum disclosed an intraluminal hypoechoic lesion of the right pulmonary artery, suggesting a thrombosis (Figure 4).
PMC3920997_05
(a) Endoscopic ultrasound view of an intraluminal thrombus (arrowheads) of the main pulmonary artery. The endoscope is advanced at the mid-oesophagus and orientated towards the anterior wall of the oesophagus. (b) Computed tomography scan showed an extension of the thrombus to the right pulmonary artery (p).
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Surprisingly, the examination of the mediastinum revealed a mobile thrombus of the pulmonary artery (Figure 5).
PMC3920997_06
(a) Endoscopic ultrasound signs of right-sided heart failure: dilation of the hepatic veins and inferior vena cava (asterisk) to 25 mm. The endoscope is positioned 1-3 cm beyond the gastro-oesophageal junction and rotated clockwise. (b) Upper abdominal contrast-enhanced computer tomography section reveals retrograde opacification of the dilated hepatic veins (arrowhead), which is a specific sign of right-sided heart failure.
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The combination of these findings indicated a right-sided heart failure and the patient was transferred to the cardiology department (Figure 6).
PMC3920997_07
(a) Endoscopic ultrasound image of a 6 cm heterogeneous hypoechoic renal mass. (b) Computer tomography image of the same lesion.
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This showed a 6 cm heterogeneous hypoechoic mass (Figure 7).
PMC3920997_08
(a) Transrectal endoscopic ultrasound examination revealed an 11 mm thickening of the urinary bladder. The endoscope is orientated towards the anterior wall of the rectum. (b) This finding was confirmed by means of magnetic resonance imaging. Fine needle aspiration cytology disclosed a linitis-plastica carcinoma of the urinary bladder.
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Inspection of the urinary bladder disclosed an 11 mm wall thickening (Figure 8).
PMC3920997_09
(a) Longitudinal EUS image of an infrarenal abdominal aortic aneurysm. The endoscope is positioned in the second portion of the duodenum, in a straight position and orientated towards the posterior-internal border of the duodenum. The asterisks highlight the circumferential thrombus that occludes approximately two thirds of the lumen. (b) Computer tomography image of the aneurysm.
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Inspection of the adjacent structures, revealed an infrarenal abdominal aortic aneurysm with a circumferential thrombus (Figure 9).