Contrast-enhanced endoscopic ultrasonography improves the preoperative localization of insulinomas.
We report a case in which endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS) and contrast-enhanced EUS using Levovist helped to localize insulinoma correctly. A 74-year-old woman complained of symptomatic fasting hypoglycemia with relatively high concentration of serum insulin level. Dynamic contrast-enhanced computed tomography revealed a small tumor of 8 mm diameter in the pancreatic head. Insulin secretion was strongly stimulated by calcium injection into the gastroduodenal artery. To clarify the precise localization, we performed EUS, IDUS and contrast-enhanced EUS. The tumor was enhanced clearly by Levovist, and the distance from the main pancreatic duct was more than 3 mm. Therefore, a preoperative decision could be made to use the enucleation method for resection of the tumor. The surgeon could enucleate the tumor in a brief operation according to the preoperative diagnosis, and serum glucose levels returned to normal range after the operation. Contrast-enhanced EUS using Levovist was shown to be a useful diagnostic method for precise localization of small insulinoma.
Kasono
Keizo
K
Department of Endocrinology and Metabolism, Jichi Medical School, Omiya Medical Center, Amanuma-cho, Saitama, Japan.
Hyodo
Takafumi
T
Suminaga
Yoshihisa
Y
Sugiura
Yasuko
Y
Namai
Kazuyuki
K
Ikoma
Aki
A
Tamemoto
Hiroyuki
H
Imawari
Michio
M
Kawakami
Masanobu
M
Ishikawa
San-e
SE
D000368:Aged; D000792:Angiography; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
D003287:Contrast Media