PMC5331846_01
Congestive and edematous duodenal mucosa of nodular appearance with slight narrowing of the lumen size
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F1
An upper endoscopy was performed showing, in the second portion of the duodenum an edematous mucosa with nodular appearance bulging into the lumen and reducing its size without obstructing the passage of the endoscope [Figure 1].
MRI: Thickening of the duodenal frame with associated cystic area. MRI = Magnetic resonance imaging
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F2
EUS: Thickening of duodenal folds of inflammatory aspect and cystic areas inside the duodenal wall. EUS = Endoscopic ultrasound
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F3
PMC5331846_02
Thickened folds of uncertain infiltrative appearance observed in gastroscopy
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F4
CT: Multilocular cystic area adjacent to the uncinate process. CT = Computed tomography
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F5
EUS: Circumferential occupation of the duodenal wall due to multilocular cystic collection with septa
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F6
Draining of the cystic collection by EUS.
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F7
EUS-guided biopsy of the cyst using a 19-G needle was performed, which achieved almost complete aspiration (amylase 20,000U/L, normal range up to 80) [Figure 7], after which the patient progressed well with significant reduction in the duodenal wall thickness, evidenced by CT; and a further control EUS 3months later [Figure 8]. Eighteen months later the patient is asymptomatic without treatment.
Post-drainage EUS control of intramural cystic collection
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F8
EUS-guided biopsy of the cyst using a 19-G needle was performed, which achieved almost complete aspiration (amylase 20,000U/L, normal range up to 80) [Figure 7], after which the patient progressed well with significant reduction in the duodenal wall thickness, evidenced by CT; and a further control EUS 3months later [Figure 8]. Eighteen months later the patient is asymptomatic without treatment.
PMC5331846_03
CT: Duodenal-pancreatic crossover fluid collection with compression of the duodenal lumen
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F9
EUS: Duodenal intramural cystic collection
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F10
PMC5331846_04
CT: Thickening of the wall of the first duodenal portion, with duodenal-pancreatic fat trabeculation
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F11
A CT was performed that identified thickening of the wall of the first portion of the duodenum, with trabeculation of duodenal-pancreatic crossover fat [Figure 11].
EUS: Intramural cystic image of less than 1 cm
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F12
An EUS was requested, showing findings consistent with chronic pancreatitis according to Rosemont criteria along with a nonstenotic thickened duodenal mucosa with lower intramural cystic area of less than 1 cm [Figure 12].