Brief:
62 year old male admitted with weight loss of 5 kilos, jaundice. 3 month history of diabetes, hypertension.

Description:

  • 62 year old male admitted with weight loss of 5 kilos, jaundice. 3 month history of diabetes, hypertension.
  • Bloods –
  • Bil 16.5 mg/dl, ALP- 622, GGT – 754, SGOT – 278
  • INR 1.5, Albumin – 3.5 gm/dl
  • Hb – 11.7 gm/dl, WBC 13000/cmm.
  • US Abdomen – ill defined lesion in the head of pancreas with dilated CBD.
  • EUS – A hypoechoic lesion in the head, genu of the pancreas with no vascular invasion.
  • Small hypoechoic lymph node in the mediastinum and gastro hepatic ligament.
  • EUS FNA done from the primary lesion showed adenocarcinoma with moderate differentiation.
  • ERCP – Brushings negative for malignancy
  • ERCP – Lower CBD stricture which was successfully palliated with an 6cm self expanding metal stent.

Expert Comments:

  • - In a study published by Binmoeller et all (GIE 2015) and Rathod et all (DDW 2015) EUS- FNA with rapid on site cytopathology evaluation vs. ERCP brushing led to a 10-15% higher histopathology yield
  • - EUS – ERCP interface allows diagnosis, staging and palliation in one sedation as a day care procedure.
  • - EUS is superior to CT scan for loco regional staging of peri luminal cancers

Take home message:

  • - EUS FNA is superior to ERCP biliary brushings.
  • - SEMS placement obviates the need for recurrent plastic stent change in patients who are deemed in operable to prevent cholangitis.
  • - New onset diabetes with abnormal LFT’s should warrant high definition pancreatic imaging.

Images:

1. Hypoechoic lesion in the genu/ head of pancreas

2.Hypoechoic lymph node in the mediastinum

 

3. EUS- FNAC of the lesion

4.ERCP Sphincterotomy

 

5.ERCP and biliary brushing

6.ERCP- SEMS insertion

 

 

Posted by Dr. Vipulroy Rathod Jan 28, 2015 Categories: Gastrovision Case Capsules
© Endoscopy Asia

Comments

Sep 07, 2016

re: old male admitted with weight loss of 5 kilos, jaundice

Oct 06, 2016

re: old male admitted with weight loss of 5 kilos, jaundice

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Nov 01, 2017
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Eqt Adidas

Today we get first look at the Kith x adidas Nemeziz Tango 17.1 courtesy of Ronnie Fieg. Said to be a part Yeezy Boost 350 V2 of the upcoming KITH x adidas Soccer Season 2 Collection, this version of the adidas Nemeziz Tango 17.1 comes dressed in an upper that utilizes Pink hues offset by Yeezy Shoes the hits of Navy and Grey noted on the toe and heel, respectively. The Light Pink upper is then given White accents which can be seen on the Three Stripes and the large KITH branding found throughout. Other features on the shoe include the White sole and the Navy leather pull tab Adidas NMD on the heel.Look for the Kith x adidas Nemeziz Tango 17.1 to release as a part of the KITH x adidas Soccer Season 2 Collection. No word yet on when Yeezy Boost 350 the collection will drop, but as soon as a release date is announced, we will be sure to let you know.
Kasina (Korean streetwear store) links up with adidas Consortium NMD Human Race to release a collaborative rendition of the semi-new adidas Superstar Boost. The collab pays homage to Kasina’s 20th anniversary and takes inspiration from the country’s artisanal heritage.This version of the Adidas NMD Superstar comes with a Bone White nubuck upper paired up with a leather shell toe. Other luxe features on the upper include the exposed stitching, the the Three Stripes logo Yeezy Boost 350 V2 in tonal stitching, Kasina and Trefoil branding on the leather tongue tag, “1997” (the year the store was found) text embroidered on to the lateral side of the heel, Tan Adidas Yeezy Boost 350 V2 leather lining and a Gum-colored sole unit with an exposed Boost placed on the medial side.Look for the adidas Consortium x Kasina Superstar Boost to drop on October 21st. Yeezy Shoes Who’s coppin?
Made for the ladies, you can now pick up the brand new adidas Campus Raw Pink. This new colorway of the model comes in a clean Raw Pink NMD XR1 and White color scheme. The Pink upper comes with a textured finish while suede hits can be found on the tongue, laces and eyestay. Offsetting the tonal look of the Yeezy Boost 750 shoe is the White found on the Three Stripes branding and heel tab. Lastly, the shoe is given an Off-White rubber sole to complete the major traits of the shoe. Adidas NMD for Sale Priced at $90, you can now find this new colorway of the adidas Campus at select adidas retailers.
Tracy McGrady was recently inducted into the Naismith Memorial Basketball Hall of NMD Adidas Fame and even though he stepped away from the NBA quite some time ago, he has kept strong ties with adidas.T-Mac recently posted the the picture you see above which Adidas Yeezy Boost 350 shows his adidas T-Mac 3 signature shoe in his high school’s team colors, the Auburndale High School Bloodhounds. The shoe features a white leather upper with royal blue suede and Yeezys For Sale yellow accents. No release date has been announced yet, but make sure you keep it locked to Kicks On Fire for updates.
Dropping earlier this month in a bright red Adidas Yeezy hue, the all-new adidas Busenitz RX has just released in a new Solid Grey color option.This new version of the Busenitz comes covered in a buttery soft pig suede all Adidas Yeezy Boost 350 throughout the upper with perforated three stripes branding on the side panels. Other details include a cat tongue inspired lining and elastic tongue wings for a locked-in fit, gold foil Cheap Yeezys Busenitz branding on the side panels, and a white rubber Spezial cupsole for comfort and protection. If you’re interested in picking up a pair you can do so now at Yeezy Boost 350 select adidas Skateboarding retailers for $85.
The adidas NMD R2 Primeknit Japan Pack Core Black was introduced a couple weeks ago and the sneaker has finally arrived at select retailers. Adidas Yeezy Boost The upper features a black stripe Primeknit pattern with a “Brand With Three Stripes” text in Japanese and it sits on top of a contrasting white Boost midsole. The translucent Yeezy Boost 350 V3 rubber outsole finishes the sneaker off by adding a nice touch.Retailing for a price tag of $170, look for this core black adidas NMD R2 Primeknit Japan at select adidas Cheap Yeezys stores and online today. Click and bookmark our Air Jordan 12 Bordeaux hub page now for the shoe’s latest release info and up-to-the-minute updates and images. Always keep it locked Adidas Yeezy to KicksOnFire for the latest in sneaker news and release dates.
After getting a first look at the upcoming adidas NMD R2 CNY yesterday, we now bring you more images Adidas NMD XR1 of the sneaker 24 hours later.These new pictures gives us a better look at the shoe as we are able to see it from new angles. The shoe features a Adidas Yeezy Boost 350 V2 white mesh upper with red accents on the heel and tongue branding, and the EVA insert on the medial midsole. Chinese characters have then been placed on the heel and Yeezy Shoes insoles while gold aglets complete the design of the sneaker.No release date has been announced yet, but stay tuned to Kicks On Fire for more updates.
There’s a new adidas Yeezy 950 Yeezy runner releasing next year and it’s being called as the adidas Yeezy Desert Rat 500. According to leaker Yeezy Mafia, that is the real name of the shoe and New Yeezys 2017 not the colorway. No details on the shoe’s release have been made public yet but it is rumored to debut in Spring 2018. This new runner features a premium upper NMD R1 made of cow leather, suede and mesh that rests on top of adiPrene+ technology instead of Boost. Click and bookmark our Air Jordan 12 Dark Grey hub page now for New Yeezys the shoe’s latest release info and up-to-the-minute updates and images. Always keep it locked to KicksOnFire for the latest in sneaker news and release dates.
For those of you that Cheap Adidas NMD love some Boost but want to be able to wear it in the rain and snow, then look no further than this upcoming collaboration from Cleveland-based boutique Xhibition.What you’re seeing Yeezy Boost 350 V2 above is the Xhibition x adidas Terrex Tracefinder. This is a new rugged hiking boot from the three stripes that will not only protect your feet from the cold and Adidas Yeezy Boost 350 V2 rainy weather thanks to the wool and leather upper that has been treated with a weather-resistant coating, but will also keep you comfortable thanks to the Boost-infused midsole.The Xhibition x Adidas Eqt adidas Terrex Tracefinder will be releasing exclusively at Xhibition on October 21st with a wider release taking place on October 28th.
The adidas Yeezy Boost 650 was leaked in Spring Infant Yeezy Boost 350 V2 2016 and even though the sneaker has not been officially revealed yet, another sample of the sneaker just released in the popular triple black colorway. The design is similar to Adidas NMD For Sale the Yeezy Boost 350 with a primeknit upper but this version sports a higher cut to the design. Heel pull tabs, Boost cushioning encased in a ribbed black sole completes Adidas Yeezy Boost 350 the look altogether.Let us know if you think adidas should make these officially available. Click and bookmark our Air Jordan 12 Dark Grey hub page now for the shoe’s latest Eqt Adidas release info and up-to-the-minute updates and images. Always keep it locked to KicksOnFire for the latest in sneaker news and release dates.

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Nov 17, 2017
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Jordan 11 Low
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Jordan 11 Low

The deadly black mamba snake has a long history in the world of sneakers. Before it became associated with Kobe Bryant, it served as the design inspiration for the Air Jordan 19 in 2004. The shoe’s sleek and unique serpentine aesthetic made Retro Jordans it one of the most popular signature Jordan models of the mid-00’s. Now the snake-inspired signature sneaker is set for a re-release 15 years after it originally dropped, New Jordans as it’s returning to market in April 2019. Set to arrive in a classic black/gold colorway, the shoe will likely feature a black patent leather toebox, large tonal Jordan 11 Shoes black mesh lace cover, and regal gold detailing on the heel collar and outsole. We’ve got a ways yet to wait until this cult-classic Jordan returns, but until Jordan Shoes then you can stay up to date on all things Jordan with our Jordan Release Dates page.
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