Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage Fockens, P.; Johnson, T.G.; van Dullemen, H.M.; Huibregtse, K.; Tytgat, G.N.J. Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Background: Endoscopic drainage of pancreatic pseudocysts has become an established alternative to surgery. We performed endosonography before endoscopic drainage to find out whether detailed anatomic information would help in the selection of appropriate candidates and result in a reduction of complications. Patients and Methods: Between April 1992 and July 1995 endosonography was performed in 32 patients, referred for endoscopic pseudocyst drainage, to determine the minimal distance between the pseudocyst and the gut, to identify interposed vascular structures, and to determine the optimal site for drainage. Results: Endosonography failed to identify a pseudocyst in 3 patients and in 2 patients the lesion was inconsistent with a pseudocyst. In 7 patients transmural drainage was considered inappropriate: in 4 the distance between the gut and the cyst was too large, in 2 varices were present between the cyst and the gut, and in 1 patient normal pancreatic parenchyma was present between the cyst and the gut. In 20 patients endosonography was followed by ERCP, and in 19 endoscopic drainage was attempted. Transmural drainage was successful in 16 patients. Endosonography changed management in 37.5% of the patients. Conclusion: Endosonography provides essential information prior to endoscopic drainage of pseudocysts, leading to a change in therapy in one third of patients. (Gastrointest

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Pancreatic neoplasms are one of the leading cause of death in the world. Multidetector computed tomography (MDCT) provides high resolution images and is useful in the detection and staging of pancreatic malignancies. The acquisition of images in arterial, venous and delayed phases improves the accuracy of diagnosing unresectable pancreatic carcinoma and also helps in identifying indirect signs of a mass with no visible pancreatic contrast in the form of atrophic distal parenchyma, interrupted duct sign and mass effect. This pictorial essay aims to depict characteristic appearance of various pancreatic neoplasms on 64 slice MDCT and their corresponding histopathological appearances.