Expanding the horizons of endoscopic ultrasound: diagnosis of non-digestive pathologies

Abstract

Endoscopic ultrasound (EUS) is mainly used for the evaluation and sampling of mediastinal and abdominal lymph nodes, luminal and submucosal lesions of the upper and lower gastrointestinal tract, as well as in the diagnostic approach for pancreatic, biliary and liver disease. However, several non-digestive pathologies may be encountered as well, expanding the diagnostic potential of EUS. In this article, we present nine examples of extra-digestive abnormalities detected by means of EUS, including pathologies of the thyroid gland, mediastinal and abdominal vessels, lungs, kidney and the urinary bladder. The purpose of this article is to review the capabilities of EUS beyond routine evaluation of gastrointestinal organs.

Keywords: Endoscopic ultrasound; aortic aneurysm; cardiac failure; pneumonia; pulmonary embolism; renal tumor; thyroid cyst.

Figure 1.

Incidental endoscopic ultrasound finding of a 17 mm multi-locular cystic lesion of the thyroid. The endoscope is advanced by 18–20 cm and is orientated towards the anterior wall of the oesophagus.

Figure 2.

(a) Linear endoscopic ultrasound view of a large pleural effusion (p) surrounding an area with tissue-like pattern resembling that of liver (asterisk). The endoscope is positioned at the upper oesophagus and orientated towards the right lateral wall (clockwise direction). (b) Computer tomography image of the same anatomical region showing an atelectatic superior upper lobe surrounded by the pleural effusion.

Figure 3.

(a) Hypoechoic lesion of the superior left lobe (arrowheads) in close contact with the left subclavian artery (c). The endoscope is advanced at the level of the aortic arch and then rotated towards the left lateral wall of the oesophagus (counterclockwise direction). (b) Computer tomography image of the same lesion.

Figure 4.

Endoscopic ultrasound image of a heterogeneous hypoechoic intraluminal lesion of the right pulmonary artery (arrowhead). The endoscope is advanced at the mid-oesophagus and orientated towards the anterior and right lateral wall of the oesophagus. Computer tomography scan showed an invasion of the right pulmonary artery (p) by the tumour (arrowhead).

Figure 5.

(a) Endoscopic ultrasound view of an intraluminal thrombus (arrowheads) of the main pulmonary artery. The endoscope is advanced at the mid-oesophagus and orientated towards the anterior wall of the oesophagus. (b) Computed tomography scan showed an extension of the thrombus to the right pulmonary artery (p).

Figure 6.

(a) Endoscopic ultrasound signs of right-sided heart failure: dilation of the hepatic veins and inferior vena cava (asterisk) to 25 mm. The endoscope is positioned 1–3 cm beyond the gastro-oesophageal junction and rotated clockwise. (b) Upper abdominal contrast-enhanced computer tomography section reveals retrograde opacification of the dilated hepatic veins (arrowhead), which is a specific sign of right-sided heart failure.

Figure 7.

(a) Endoscopic ultrasound image of a 6 cm heterogeneous hypoechoic renal mass. (b) Computer tomography image of the same lesion.

Figure 8.

(a) Transrectal endoscopic ultrasound examination revealed an 11 mm thickening of the urinary bladder. The endoscope is orientated towards the anterior wall of the rectum. (b) This finding was confirmed by means of magnetic resonance imaging. Fine needle aspiration cytology disclosed a linitis-plastica carcinoma of the urinary bladder.

Figure 9.

(a) Longitudinal EUS image of an infrarenal abdominal aortic aneurysm. The endoscope is positioned in the second portion of the duodenum, in a straight position and orientated towards the posterior-internal border of the duodenum. The asterisks highlight the circumferential thrombus that occludes approximately two thirds of the lumen. (b) Computer tomography image of the aneurysm.