title: Contrast-enhanced endoscopic ultrasonography improves the preoperative localization of insulinomas.
abstract: 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.
authors.affiliation: Department of Endocrinology and Metabolism, Jichi Medical School, Omiya Medical Center, Amanuma-cho, Saitama, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Kasono
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hyodo
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Suminaga
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Namai
authors.forename: Aki
authors.initials: A
authors.lastname: Ikoma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tamemoto
authors.forename: Michio
authors.initials: M
authors.lastname: Imawari
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kawakami
authors.forename: San-e
authors.initials: SE
authors.lastname: Ishikawa
mesh_terms: 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
chemical_list: D003287:Contrast Media