case_images: PMC5331846_01
case_images: Congestive and edematous duodenal mucosa of nodular appearance with slight narrowing of the lumen size
case_images: EUS-6-61-g001.jpg
case_images: PMC5331846_01_EUS-6-61-g001.jpg
case_images: F1
case_images: 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].
case_images: MRI: Thickening of the duodenal frame with associated cystic area. MRI = Magnetic resonance imaging
case_images: EUS-6-61-g002.jpg
case_images: PMC5331846_01_EUS-6-61-g002.jpg
case_images: F2
case_images: EUS: Thickening of duodenal folds of inflammatory aspect and cystic areas inside the duodenal wall. EUS = Endoscopic ultrasound
case_images: EUS-6-61-g003.jpg
case_images: PMC5331846_01_EUS-6-61-g003.jpg
case_images: F3
case_images: PMC5331846_02
case_images: Thickened folds of uncertain infiltrative appearance observed in gastroscopy
case_images: EUS-6-61-g004.jpg
case_images: PMC5331846_02_EUS-6-61-g004.jpg
case_images: F4
case_images: CT: Multilocular cystic area adjacent to the uncinate process. CT = Computed tomography
case_images: EUS-6-61-g005.jpg
case_images: PMC5331846_02_EUS-6-61-g005.jpg
case_images: F5
case_images: EUS: Circumferential occupation of the duodenal wall due to multilocular cystic collection with septa
case_images: EUS-6-61-g006.jpg
case_images: PMC5331846_02_EUS-6-61-g006.jpg
case_images: F6
case_images: Draining of the cystic collection by EUS.
case_images: EUS-6-61-g007.jpg
case_images: PMC5331846_02_EUS-6-61-g007.jpg
case_images: F7
case_images: 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.
case_images: Post-drainage EUS control of intramural cystic collection
case_images: EUS-6-61-g008.jpg
case_images: PMC5331846_02_EUS-6-61-g008.jpg
case_images: F8
case_images: 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.
case_images: PMC5331846_03
case_images: CT: Duodenal-pancreatic crossover fluid collection with compression of the duodenal lumen
case_images: EUS-6-61-g009.jpg
case_images: PMC5331846_03_EUS-6-61-g009.jpg
case_images: F9
case_images: EUS: Duodenal intramural cystic collection
case_images: EUS-6-61-g010.jpg
case_images: PMC5331846_03_EUS-6-61-g010.jpg
case_images: F10
case_images: PMC5331846_04
case_images: CT: Thickening of the wall of the first duodenal portion, with duodenal-pancreatic fat trabeculation
case_images: EUS-6-61-g011.jpg
case_images: PMC5331846_04_EUS-6-61-g011.jpg
case_images: F11
case_images: 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].
case_images: EUS: Intramural cystic image of less than 1 cm
case_images: EUS-6-61-g012.jpg
case_images: PMC5331846_04_EUS-6-61-g012.jpg
case_images: F12
case_images: 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].