Editor: Ian Penman
5. EUS: pancreatico-biliary
Fig. 1 Portal confluence with SMA (radial).
Fig. 2 Pancreatic body. The renal vessels can be mistaken for being the splenic vein, but they run a straighter course (radial).
Fig. 3 Cartoon of relative position of splenic and renal vessels when viewing the body/tail of pancreas (radial).
Fig. 4 Cartoon of relative scope movements to view body and tail of pancreas (radial).
Fig. 5 Celiac trunk and superior mesenteric artery (linear).
Fig. 6 Cartoon of pancreatic body (linear).
Fig. 7 Cross section of mid-pancreatic body with splenic vein and artery (linear).
Fig. 8 Cartoon of movements to view tail and neck of pancreas from the mid-body position (linear).
Fig. 9 Cartoon of the portal confluence and neck of pancreas with views through to the head of pancreas (linear).
Fig. 10 Neck of pancreas with course of pancreatic duct outlined (linear).
Fig. 11 Cartoon of the portal confluence (linear).
Fig. 12 (A) Cartoon of the portal vein and common bile duct at the liver hilum (linear). (B) Linear view from the stomach of
the common hepatic/bile duct with the left and right hepatic ducts (LH, RH), lying behind the portal vein (PV). The C-shaped hilum of the liver
Fig. 13 The major structures seen from the duodenal bulb (gallbladder, portal vein, and common bile duct) generally lie to the left
of the screen (radial).
Fig. 14 The common bile duct, portal vein, and pancreatic duct fashion a type of triangle with the apex at the liver hilum and the
lower right corner at the ampulla (radial).
Fig. 15 Cartoon of anatomic orientation when performing radial EUS from the duodenal bulb (radial).
Fig. 16 Views from the second part of the duodenum. The spine lies at 12 o'clock, with the major vessels immediately under this (radial).
Fig. 17 As the aorta elongates, the superior mesenteric vessels are seen to unfold to the left of the screen (radial).
Fig. 18 A coronal view of the left renal vein is seen as it crosses in front of the aorta, close to the origin of the superior mesenteric
Fig. 19 The pancreatic duct, followed by the common bile duct, come into view as the scope is withdrawn from the second part of the
Fig. 20 View from the duodenal bulb (linear).
Fig. 21 Cartoon showing the arc described by the portal and superior mesenteric veins (linear).
Fig. 22 Cartoon of the relatively horizontal course followed by the pancreatic duct from the portal vein to the ampulla (linear).
Fig. 23 The aorta and uncinate process are seen when the scope is in the second part of the duodenum (linear).
Fig. 24 Cartoon of the relative position of the common bile duct when seen from deep D2 or the duodenal bulb (linear).
Fig. 25 Distal common bile duct stone with acoustic shadow.
Fig. 26 Sludge in the common bile duct close to the ampulla.
Fig. 27 Biliary microcrystals in the gallbladder.
Fig. 28 Marked thickening of the common bile duct wall due to primary sclerosing cholangitis.
Fig. 29 Neuroendocrine tumor of the ampulla of Vater.
Fig. 30 Cholangiocarcinoma with adhesion to the portal vein.
Fig. 31 Salt-like microcrystals in the common hepatic duct.
Fig. 32 Lobulation of the pancreatic parenchyma (normal duct).
Fig. 33 Pancreatic serous cystadenoma. Note the cysts of varying size (medium/small).
Fig. 34 The multiple, thin septated cysts of von HippelLindau syndrome.
Fig. 35 Mucinous cystadenoma of the pancreas.
Fig. 36 Chronic calcific pancreatitis.
Fig. 37 Intraductal mucinous papillary tumor of the pancreatic head with gross ductal dilatation and invasion of the parenchyma. Note
'stranding' due to mucous.
Fig. 38 Pancreatic adenocarcinoma abutting the portal vein (white interface preserved).
Fig. 39 Pancreatic adenocarcinoma with adherence to the portal vein (complete loss of interface).
Fig. 40 Pancreatic carcinoma with invasion/encasement of the portal vein.
Copyright © Blackwell Publishing, 2005