Submitted by jp on Tues: “Looking at this I first thought it was a mass in the right pancreas pushing on the pylorus but I think it is not part of the pancreas. I am having a hard time determining if this is intra-mural or not. Could this be a leiomyoma, leiomyosarcoma, other? I have recommended surgical referral and liver biopsy.”

Submitted by r on Tue: “In the final cine loop- it almost appears that there are parallel lines inside the mass- like you would expect from hepatic portal vasculature- what is that? No shadowing but there is refractive artifact.”

Submitted by EL on Tue: “Any power doppler over the lesion? It derives from the mucosa looks like as the submucosa runs under it or its cauloflowering out of the muscularis which Leios can do. But is has mural abscess look to it which would be doppler negative whereas a mass would be doppler +. Looks resectable wiht a billroth and no LN seen in the views which carcinoma and lymphoma usually sdo at this point… So mural abscess or Leio are my top 2 and doppler and a needle tell you which one. 🙂 With the needle this is one that I would actually go through the lumen so if abscess and minor leak it leaks into the gastric lumen and not into the peritoneal cavity. 25 gauge would be what i would do but you know me jp I wear a cowboy hat at times with a needle in hand:) If the 25 g goes into a hard structure then corkscrew 22 or 20 gauge would help exfoliate a leio.

Submitted by jp on Tue: “I have uploaded two clips with colour Doppler. As you can see there is alot of movement artifact but I think that you can argue there was a solid signal of what looks like blood flow in the second clip.”

Submitted by EL on Tue: “The second clip has a solid feeder vessel im guessing a 22 g and since its solid you can go through the gastric wall avoiding the lumen or send right to sx.”

**Forum post: https://sonopath.com/forum/pyloric-mass