This text examines pathologic images seen during EUS. The digital anatomy correlation used in this work is the natural continuation of efforts to apply the University of Colorado Visible Human data set to gastroenterology.
The Visible Human data set was created by Dr. Vic Spitzer and colleagues at the University of Colorado and is currently housed at the university's Center for Human Simulation. The data set consists of high resolution transaxial digital images captured as cadavers were abraded away at 1 mm or less depths. These images are compiled into blocks of data and each structure is identified. This information can be used to pull out and manipulate 3-D structures as well as allowing one to review planar anatomy in any orientation. Using the Visible Human dataset, one should be able to find a normal anatomy correlate to any image found during a EUS examination.
However, as important as normal anatomy is, it is the abnormal features which are the crux of an EUS examination.
Endosonographers are asked to define lumps, bumps, cysts to find correlates for symptoms and abnormal laboratory findings.
Accuracy requires a tremendous amount of skill and experience. To help in this task, we have assembled chapters from a world-wide group of expert endosonographers. These authors have shared their insight and images to help the readers of this work better see and understand some of the complexities uncovered during a EUS evaluation.
Manoop S. Bhutani, MD, FACG, FACPCo-Director, CERTAINDirector, Center for Endoscopic UltrasoundDepartment of Internal MedicineThe University of Texas Medical BranchHouston TX John C. DeutschInternal Medicine, Gastroenterology, Hematology/OncologyDuluth Clinic, Duluth MN
1: Introduction and Overview 2a: EUS Staging of Early Esophageal Carcinoma 2b: EUS in the Management of Barrett's Esophagus and Early Esophageal Adenocarcinoma 2c: EUS in Advanced Esophageal Cancer 3a: Endosonographic staging of early gastric cancer 3b: Endoscopic Ultrasonography of Advanced Gastric Cancer 4: Large Gastric Folds 5: Subepithelial Lesions of the Upper GI Tract 6: EUS anatomy of esophago-gastric varices 7: Vascular Abnormalities 8: Eus for Mediastinal Lymph Nodes and Masses 9: EUS with FNA for primary lung tumors 10: Endobronchial Ultrasound 11: Diagnosing and Staging of Pancreatic Cancer 12: Pancreatic and Peripancreatic Neuroendocrine Tumors 13: Pancreatic Metastases 14: Pancreatic Cystic Lesions 15: The Role of Endoscopic Ultrasonography. 16: EUS Features of Chronic Pancreatitis 17: EUS in Autoimmune Pancreatitis 18: Pancreaticobiliary Ductal Anomalies 19: Endoscopic Ultrasound for the evaluation of Choledocholithiasis 20: Malignant bile duct lesions 21: Benign and Malignant Lesions of the Gallbladder 22: Ampullary Lesions 23: Liver Lesions 24: Splenic Lesions 25: EUS in the Evaluation of Adrenal Glands 26: Portal Vein Thrombosis 27: Peritoneal and Pleural Fluid 28: Endorectal Ultrasound and Rectal Cancer 29a: Anorectal Abszess 29b: Anorectal Fistulae 29c: Anal Sphicter Defects 30: Rectal EUS in the examintion... 31: Subepithelial Colorectal Lesions 32: Urologic Echoendoscopy 33: Endoscopic Ultrasound in Inflammatory Bowel Disease 34: Endoscopic Ultrasound Elastography 35: Contrast enhanced Endoscopic Ultrasonography