Sonopath Forum

Hypoechoic nodules associated with left pancreatic limb

- - 10 year old FS DSH presented for chronic weight loss, decreased appetite with normal CBC/Chem, T4 and UA. Mild conjunctivitis and URI symptoms over past few months. but appetite does not improve even when no symptoms. Had a fever when symptoms first started in November 2021. Most recent CBC shows a lymphompenia
  - Abdominal US shows multiple hypoechoic nodules in the region of the left pancreatic limb, decreased pancreatic body echogenicity, thickened ileal muscularis layer, decreased renal corticomedullary definition, echogenic gallbladder wall of normal thickness.
  - Multiple US guided FNA of the hypoechoic nodules were nondiagnostic (RBCs, few WBC’s. otherwise low cellularity)
  - R/O’s for the hypoechoic nodules include benign pancreatic adenomas, pancreatic carcinoma, abnormal lymph nodes or some other neoplasia.
  - Since these nodules do not exfoliate well, would you consider surgical biopsies (pancreatic nodules, ileum) as a next step?