EUS may be performed with a concomitant FNA or biopsy. EUS offers high-resolution sonographic imaging of the head of the pancreas/distal CBD, and as such can be used to detect small distal biliary ductal calculi, can locally stage pancreatic or periampullary neoplasms, and can guide FNA or biopsy [76-80]. EUS is limited by its narrow field of view and therefore cannot detect pathology outside of its imaging field of view (ie, cannot see pathology beyond the region to which the sonographic probe is physically adjacent) [81,82]. Complications from EUS have been reported in up to 6.3% of patients (most commonly postprocedural pancreatitis) [83]. The sensitivity, specificity, and accuracies of EUS with FNA biopsy for solid pancreatic tumor are 90.8%, 96.5%, and 91%, respectively [79,84,85]. Variant 3: Jaundice. Suspected medical, metabolic, or functional etiologies based on initial imaging, clinical condition, or laboratory values. No suspected mechanical obstruction. Patients with unconjugated hyperbilirubinemia (nonobstructive) jaundice most commonly have diffuse hepatocellular disease (eg, cirrhosis, hepatitis), inability of the liver to handle a bilirubin load (eg, hemolytic anemia), or a bilirubin metabolism deficiency (eg, Gilbert disease [1], Crigler-Najjar syndrome, etc). Differentiating between these nonobstructive etiologies of jaundice is typically done through analysis of characteristic history and physical examination findings, as well as diagnostic laboratory profiles. If imaging is performed in these settings, it will confirm the absence of a mechanical obstruction and may point to an alternate etiology for the elevated bilirubin levels (eg, features of liver cirrhosis) [32]. Therefore, the largest role of imaging in unconjugated hyperbilirubinemia is in excluding other potential diagnoses. Jaundice US Abdomen In the initial setting of jaundice with a laboratory and clinical picture suggestive of a lack of biliary obstruction, US is usually performed as the initial evaluation [32].
Jaundice. EUS may be performed with a concomitant FNA or biopsy. EUS offers high-resolution sonographic imaging of the head of the pancreas/distal CBD, and as such can be used to detect small distal biliary ductal calculi, can locally stage pancreatic or periampullary neoplasms, and can guide FNA or biopsy [76-80]. EUS is limited by its narrow field of view and therefore cannot detect pathology outside of its imaging field of view (ie, cannot see pathology beyond the region to which the sonographic probe is physically adjacent) [81,82]. Complications from EUS have been reported in up to 6.3% of patients (most commonly postprocedural pancreatitis) [83]. The sensitivity, specificity, and accuracies of EUS with FNA biopsy for solid pancreatic tumor are 90.8%, 96.5%, and 91%, respectively [79,84,85]. Variant 3: Jaundice. Suspected medical, metabolic, or functional etiologies based on initial imaging, clinical condition, or laboratory values. No suspected mechanical obstruction. Patients with unconjugated hyperbilirubinemia (nonobstructive) jaundice most commonly have diffuse hepatocellular disease (eg, cirrhosis, hepatitis), inability of the liver to handle a bilirubin load (eg, hemolytic anemia), or a bilirubin metabolism deficiency (eg, Gilbert disease [1], Crigler-Najjar syndrome, etc). Differentiating between these nonobstructive etiologies of jaundice is typically done through analysis of characteristic history and physical examination findings, as well as diagnostic laboratory profiles. If imaging is performed in these settings, it will confirm the absence of a mechanical obstruction and may point to an alternate etiology for the elevated bilirubin levels (eg, features of liver cirrhosis) [32]. Therefore, the largest role of imaging in unconjugated hyperbilirubinemia is in excluding other potential diagnoses. Jaundice US Abdomen In the initial setting of jaundice with a laboratory and clinical picture suggestive of a lack of biliary obstruction, US is usually performed as the initial evaluation [32].