EUS imaging of dead Ascaris

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Presentation transcript:

EUS imaging of dead Ascaris Malay Sharma, MD, DM, Piyush Somani, MD, DM, Saurabh Jindal, MD, DM, Ritesh Prajapati, MD, DM, Suthanu Bahuleyan, MD, DM, Amit Pathak, DMRD VideoGIE Volume 3, Issue 1, Pages 23-25 (January 2018) DOI: 10.1016/j.vgie.2017.09.004 Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Linear EUS view from the stomach showing dilated CBD with rounded hyperechoic structure without acoustic shadowing in the lower CBD. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Linear EUS view showing rounded hyperechoic structure in dilated common bile duct. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Linear EUS view from duodenal bulb with color Doppler image showing hyperechoic avascular structure with a central anechoic area inside the common bile duct. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Dual-color Doppler image showing avascular hyperechoic structure with vascular portal vein. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 5 Zoom image showing dead Ascaris attached to the wall of the CBD from 1 discrete attachment point, whereas the remaining structure was noted to move with the pulsatile flow of biliary secretions. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 6 The central part of the hyperechoic structure was anechoic. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 7 After biliary sphincterotomy and multiple balloon sweeps on ERCP, yellow fragments were removed, suggestive of recently fragmented Ascaris. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 8 US view of the abdomen showing CBD with stent inside. CBD, common bile duct. VideoGIE 2018 3, 23-25DOI: (10.1016/j.vgie.2017.09.004) Copyright © 2017 American Society for Gastrointestinal Endoscopy Terms and Conditions