Introduction: Despite advances in imaging techniques, the differentiation between pancreatic cancer and benign lesions remains difficult. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an effective method for providing tissue diagnosis, but problems occur when lesions are small or the cytological diagnosis is indeterminate. Aim: To prospectively evaluate the utility of EUS-FNA in patients with small solid pancreatic lesions and those with initial indeterminate or negative cytological diagnosis. Methods: During the study period we performed a total of 119 EUS-FNA procedures on 46 patients (mean age 56.3 years) for 47 small solid pancreatic lesions (range 7–30 mm, mean 17.2 mm in diameter). FNAs were performed in the presence of a cytopathologist. If cytological diagnoses were indeterminate, EUS-FNA was repeated within 3 weeks. Diagnoses were confirmed histologically or by follow-up (clinical and imaging: EUS +/– FNA and CT). Results: Localization of the lesions: head 28 (60%), uncinate process 4 (9%), body 11 (23%) and tail 4 (9%). On average, 3.7 passes were performed. We observed no complications. Initial cytological findings were: malignant 17 (36%), benign 21 (45%), and indeterminate 9 (19%). 8 (78%) of the indeterminate findings were confirmed to be malignant on repeated procedures. A diagnosis of pancreatic cancer was subsequently confirmed in 1 patient who had a benign cytological finding. 19 patients underwent surgery. Histology confirmed a neoplasm in all cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 68, 100, 100, 73 and 83%, respectively. After repeated EUS-FNAs of indeterminate findings sensitivity, negative predictive value and diagnostic accuracy rose to 92, 77 and 96%, respectively. Conclusion: EUS-FNA is a highly effective method for providing tissue diagnosis in patients with small solid pancreatic masses. Repeated procedures enhanced diagnostic accuracy in indeterminate findings, among which was high percentage of malignancies. EUS-FNA reduced the number of operations in patients with pancreatic solid masses.

Cases of common bile duct (CBD) wall thickening due to varicose dilation of intramural veins consequential to portal vein thrombosis (PVT) are rare and present a considerable differential diagnostic problem, as they can mimic cholangiocarcinoma. In such cases, colour Doppler ultrasound (CD US) is a very valuable diagnostic method. There are only a few reports in literature on CD US findings of collateral circulation in a thickened CBD wall following PVT. A patient with obstructive jaundice, a tumour of the pancreatic head, CBD wall thickening, and pre-existing PVT is presented. CD US demonstrated collateral circulation of the thrombosed portal vein in the thickened wall of the common bile duct, thus ruling out a mass in the CBD. Obstructive jaundice seldom occurs with choledocal varices. In this patient, the bile duct obstruction was due to the carcinoma of the pancreatic head.

Fibrous cortical defects are local disturbances of ossification, most commonly seen in the metaphysis of tubular bones in growing children. These lesions are usually clinically silent, and most of them heal by being replaced with normal bone. Along with typical age, location and absence of clinical symptoms, plain radiographic films allow the diagnosis of fibrous cortical defect to be made. Because of rare but occasionally occurring complications, follow-up examinations are necessary. In a child with fibrous cortical defect the ultrasound examination demonstrated that fibrous cortical defects display a rather typical sonographic image. One finds clearly delineated defects of the bone located in the vicinity of the knee joint, filled with hypo-echogenic soft tissue, also displaying prominent internal vascularisation on colour-Doppler. We followed this patient up with repeated US examinations revealing the lesions to be shrinking in size and becoming shallower. Echogenic foci within the lesions appeared. It could be presumed that these changes represent the healing process and are comparable to the areas of sclerosis seen on CT scans. We believe that ultrasound with all its benefits is a powerful complementary method for the diagnosis and follow-up of fibrous cortical defects in children.