Search

Insulinoma is the most common functional neuroendocrine tumor that originates from the islet of beta cells [1]. Advances of various diagnostic imaging methods have dramatically increased our ability to detect pancreatic diseases [2]. In particular, the ultrasonography plays an important role in the screening of pancreatic ailments [3]. Due to the small dimension of the mass, the clinicians face difficulties in diagnosing it. We present the case of a 69 years old patient diagnosed with pancreatic insulinoma which underwent imagistic examination. The patient known with hypertension and non-alcoholic steatohepatitis presented in the clinic for syncopes, sweating, anxiety and severe wight-loss. In the patient medical history, we found an emergency admission one month earlier for episodes of loss of consciousness, tremor of the upper limbs, sweating and disorientation in time and space. Abdominal ultrasonography and computed tomography showed a heterogenous 1,4 cm tumour localized in the pancreatic body with features of insulinoma. The prolonged supervised fast test that was applied induced hypoglycaemic symptoms. The level of glucose and insulin was at the lower range of the fast test. The presence of tumor was confirmed by endoscopic ultrasound, but the cytopathologic examination suggested an aspect of chronic pancreatitis. Through imaging methods and with an evocative clinical portrayal, we identified the pancreatic tumor as being an insulinoma. Even though cytology didn't support the diagnosis, we tend to believe that a false negative result cannot be ruled out. We underline the need of other specific tests in this situation. [ABSTRACT FROM AUTHOR]

Standard ultrasound is an excellent method for assessing gallbladder disease. Despite the well-known advantages of conventional ultrasound, the sensitivity and accuracy are not satisfactory, especially when stones or some other gallbladder lesions fill the gallbladder lumen. Sometimes the bladder sediment may present as an intraluminal mass and mimic tumors such as gallbladder cancer or adenoma. With no information of micro vascularity differential diagnosis between benign diseases from malignant diseases is sometimes very difficult using conventional ultrasound, but CEUS can be a useful tool. The study was performed in the Gastroenterology Clinic of SCJU Craiova during 2018-2022. 38 patients with ultrasound-detected gallbladder formations were included. The reference methods for diagnosis were histological examination or computed tomography in cases without operative indication. A single experienced physician with more than fifteen years' experience performed CEUS examinations by applying a second-generation blood pool agent (SonoVue®, Bracco, Milan, Italy). Archived images were interpreted by the same physician and compared to the final diagnosis. There were 12 malignant and 26 benign gallbladder lesions in total in this study, including 12 cases of gallbladder cancer, 16 case of gallbladder sludge and 10 cases of gallbladder polyps. All the cases of gallbladder sludge were shown as completely nonenhanced on CEUS, and the diagnostic accuracy was 100%. CEUS exam shows homogeneously hyperenhanced on arterial phase and isoenhanced on venous phase in gallbladder polyps, The appearances of gallbladder cancer on CEUS were various: a mass in gallbladder which was heterogeneously hyperenhanced on arterial phase and washed out quickly or an irregular thickness of gallbladder, which was also heterogeneously hyperenhanced on arterial phase and washed out quickly. Gallbladder sludge and gallbladder cancer had completely different features on CEUS and the diagnostic accuracy was very high. CEUS is a feasible alternative tool to differentiate gallbladder pathologic alterations. [ABSTRACT FROM AUTHOR]