LAUSR

A 56-year-old woman was transferred from an outside hospital owing to concern about pancreatic duct (PD) obstruction and a pancreatic head mass. The patient had been admitted 1 week prior to the transfer with abdominal pain radiating to the waist and back, accompanied by nausea and vomiting. Her symptoms had since resolved with supportive measures, including anti-inflammatories and analgesics. Physical examination on admission did not reveal a jaundiced complexion and her abdomen was soft without tenderness. Outpatient laboratory results demonstrated a mildly elevated cancer antigen 199 (CA199) at 41.02U/ mL, but liver function panel, and serum and urinary amylase were within the normal ranges. Abdominal computed tomography (CT) at the previous hospital had shown PD dilatation and pancreatic head enlargement (▶Fig. 1). After admission, the patient underwent endoscopic ultrasonography (EUS). EUS from the stomach showed the PD dilatation in the body and tail of the pancreas (▶Fig. 2 a). The scan of the neck of the pancreas revealed a solid round hyperechoic lesion without acoustic shadowing in the PD (▶Fig. 2b), so PD stones were ruled out. A linear hyperechoic area was seen in the PD within the pancreatic head during scanning from the duodenal bulb, but there was no central hypoechoic rim (“innertube” sign) (▶Fig. 2 c). Sideviewing endoscopy showed the shape and size of the duodenal papilla were normal and no worms were noticed within the intestines. EUS from ampulla demonstrated the PD and bile duct openings were normal. A repeat pancreatic head scan from the descending duodenum E-Videos