Endoscopic ultrasonography findings in autoimmune pancreatitis

Figure 1 Diffuse form of autoimmune pancreatitis. A: Endoscopic ultrasonography (EUS) linear scanning shows a diffuse pancreatic enlargement (arrowheads) with echopoor echotexture, and with loss of interface with splenic vein (arrows); B: Parenchymal lobularity and hyperechoic strands (arrows) are visible in the enlarged gland; C: Pancreatic duct calliper is 1.8 mm; D: EUS-elastography demonstrates the diffuse pancreatic stiffness (arrowheads).

Figure 2 Focal form of autoimmune pancreatitis. A: Endoscopic ultrasonography (EUS) shows a focal lesion (arrows) of pancreatic head which is echopoor with hyperechoic strands; B: A EUS-guided fine needle aspiration is performed (arrow) for tissue characterization; C: Another case of focal autoimmune pancreatitis (AIP) with echopoor lesion of pancreatic head (between callipers) and marked echopoor thickening of the choledochal wall (arrow); D: In this case of focal AIP EUS shows a echopoor lesion (arrows) of pancreatic head, with upstream dilatation of both common bile duct (c) and pancreatic duct (w); notice the thickened choledochal wall.

Figure 3 Biliary and peripancreatic findings in autoimmune pancreatitis. Autoimmune pancreatitis presenting with jaundice: A: Endoscopic ultrasonography (EUS) shows a dilated common bile duct (c) upstream to a distal funnel-shaped stenosis; EUS demonstrates the diffuse thickening of the biliary wall (between arrows) with “sandwich-pattern”, either of common bile duct or of cystic duct (arrowheads). This thickening is equally visible both in the dilated region of the common bile duct; B: In the distal strictured tract (arrows); C: After contrast administration (Sonovue, Bracco) the biliary wall shows an early and persistent enhancement (arrowheads); D: EUS shows the same thickening of the gallbladder (g) wall (arrowheads); E: Enlarged lymph nodes to the hepatic hylum (arrows).