A 60-year-old woman with epigastric pain radiating to her back and consumptive syndrome.
Abdominal ultrasound showed a 4 x 6 cm mass in the head of the pancreas, with poorly defined edges, heterogeneous and hypoechogenic, without vascular invasion or free fluid and two hepatic nodules of nonspecific nature.
The study was completed by injection of a conventional 2.4 ml bolus of ultrasonographic contrast sulfur hexafluoride (Sonovue®, Bracco, Milan).
The arterial phase (10-30 seconds) defined a hypocapnic pancreatic mass in relation to the parenchyma vesicoureteral artery stenosis.
In the venous phase (30-120 seconds), patency of the venous axis was demonstrated, while the late phase hepatic scan (> 120 seconds) detected multiple hypocapsules.
In summary, ultrasound images were compatible with a malignant pancreatic mass with arterial vascular and metastatic hepatic invasion.
These data were corroborated by a Helicon TAC.
Figure 1 shows that angiographic images with contrast-enhanced ultrasound and CT angiography were comparable.
Ultrasound-guided FNA of a hepatic nodule was diagnostic of pancreatic adenocarcinoma.
The patient underwent chemotherapy.
