Patient Profile
Patient Name
Mrs. Sunita Deshmukh
Consultant
Dr. Vipulroy Rathod
Diagnosis
Pancreatic Lesion (Head of Pancreas) — Confirmed on EUS-Guided Tissue Sampling After Inconclusive CT
Age / Gender
58 Years / Female
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Type 2 diabetes mellitus (recently diagnosed) · Mild fatty liver · No prior abdominal surgery
Patient Background
Mrs. Sunita Deshmukh, a 58-year-old homemaker from Nashik, Maharashtra, presented with vague upper abdominal discomfort, unintentional weight loss, and a recent diagnosis of diabetes. A contrast-enhanced CT scan of the abdomen at a local centre showed a subtle area of altered attenuation in the head of the pancreas, but the radiologist was unable to confirm whether it represented a true mass or an inflammatory change, and no clear tissue diagnosis could be obtained. Concerned by the uncertainty and the “inconclusive” report, her family sought a second opinion from a gastroenterologist in Mumbai with specific expertise in pancreatic imaging. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of Endoscopic Ultrasound with over 20,000 EUS procedures, recommended a detailed EUS examination with tissue sampling to characterise the lesion precisely and reach a definitive diagnosis.
Symptoms
Vague upper abdominal discomfort
dull, intermittent pain radiating toward the back
Unintentional weight loss
over the preceding two months
New-onset diabetes
poor sugar control despite no prior history
Mild loss of appetite
with early satiety after small meals
No jaundice at presentation
skin and eyes remained normal in colour, though the lesion was close to the bile duct
Diagnostic Method
Contrast-enhanced CT abdomen (outside hospital)
showed a subtle attenuation change in the pancreatic head; inconclusive for a definite mass, and unable to differentiate tumour from focal inflammation
Endoscopic Ultrasound (EUS)
high-resolution imaging from within the stomach and duodenum clearly delineated a well-defined hypoechoic lesion in the head of the pancreas that CT had failed to characterise
EUS-guided Fine Needle Aspiration/Biopsy (EUS-FNA/FNB)
real-time, needle-guided sampling of the lesion under ultrasound vision obtained adequate tissue for a definitive diagnosis
MRCP (Magnetic Resonance Cholangiopancreatography)
assessed the relationship of the lesion to the pancreatic duct and bile duct
Tumour marker panel (CA 19-9, CEA)
used as supportive, adjunct information alongside the tissue diagnosis
Disease Diagnosed
EUS-guided tissue sampling confirmed a solid lesion in the head of the pancreas, a finding CT alone could not reliably characterise due to the limits of cross-sectional imaging in small pancreatic lesions. As a gastroenterology specialist with extensive experience in pancreatic disease, Dr. Rathod identified Endoscopic Ultrasound (EUS) as the modality of choice to resolve the diagnostic uncertainty, obtain tissue, and accurately stage the lesion in relation to the surrounding vessels and ducts — information essential for planning the next step of care.
Risks of Leaving an Inconclusive Pancreatic Lesion Uninvestigated
Delay in diagnosis, allowing a potentially early, treatable lesion to progress
Missed opportunity for curative treatment if the lesion proves malignant
Continued, unexplained diabetes and weight loss without a clear cause
Anxiety and delayed care from repeated inconclusive imaging without a tissue diagnosis
Treatment Plan
Dr. Vipulroy Rathod performed a detailed Endoscopic Ultrasound (EUS) examination with EUS-guided fine needle sampling, converting an inconclusive CT finding into a precise, tissue-confirmed diagnosis to guide the correct next line of treatment.
Why EUS Was Chosen Over Repeat Cross-Sectional Imaging
01 — Superior Resolution for Small Pancreatic Lesions
EUS visualises the pancreas from millimetres away through the stomach and duodenal wall, detecting and characterising lesions that CT can miss or misread.
02 — Real-Time Tissue Diagnosis
EUS-guided FNA/FNB allows sampling of the lesion under direct ultrasound vision in the same sitting, avoiding repeated scans and diagnostic delay.
03 — Accurate Local Staging
EUS clearly defines the lesion’s relationship to the pancreatic duct, bile duct, and major blood vessels, guiding whether further treatment can proceed safely.
04 — Minimally Invasive, Day-Care Procedure
Performed entirely through the endoscope with no incision, allowing the patient to recover quickly and return home the same or next day.
How the Procedure Was Performed
- High-definition endoscopic positioning — the echoendoscope was passed through the mouth into the stomach and duodenum to access the pancreatic head.
- Systematic EUS survey — the entire pancreas was scanned in detail to reconfirm the lesion seen on CT and assess its exact size, margins, and echo pattern.
- Doppler assessment — blood flow around the lesion was evaluated to map its relationship to adjacent vessels before sampling.
- EUS-guided FNA/FNB — a fine needle was advanced under real-time ultrasound guidance into the lesion, and multiple passes were taken to obtain adequate tissue.
- On-site sample handling — the aspirated tissue was prepared and sent for cytological and histopathological analysis.
- Ductal and vascular mapping — the pancreatic duct, bile duct, and surrounding vessels were assessed to complete accurate local staging.
- Post-procedure observation — the patient was monitored for pain, bleeding, and signs of pancreatitis before discharge planning.
Procedure Summary
| Procedure | Endoscopic Ultrasound (EUS) with EUS-guided Fine Needle Aspiration/Biopsy of pancreatic head lesion |
| Imaging Used | Endoscopic Ultrasound with Doppler; correlation with prior CT and MRCP |
| Duration | 45 minutes |
| Sedation | Deep sedation with anaesthesia support |
| Hospital Stay | Day-care procedure, discharged the same evening after an uneventful recovery period |
Doctor’s Quote
“CT scans are excellent for many things, but small pancreatic lesions can genuinely sit at the edge of what cross-sectional imaging can resolve. Endoscopic Ultrasound lets us look at the pancreas from just a few millimetres away and, in the same sitting, take a precise tissue sample under direct vision. For Mrs. Deshmukh, this turned an inconclusive report into a clear, tissue-confirmed diagnosis, which is the essential first step before deciding on any further treatment. An accurate diagnosis, reached quickly and safely, is often the most important thing we can offer a patient with a pancreatic finding.”
Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Clear liquids for a few hours, advancing to a normal diet the same evening once fully alert
Monitoring for abdominal pain, fever, or vomiting suggestive of post-procedure pancreatitis
Avoid alcohol and heavy meals for a few days after the procedure
Continue diabetes monitoring and medication as advised, given the new-onset diabetes
Prompt review of the histopathology report with Dr. Vipulroy Rathod to plan the next step of care
Follow-up consultation to discuss findings and, if needed, further staging or treatment planning
Outcome
| Timepoint | Result |
| Within 24 hrs | Stable and comfortable, no pain, no bleeding, tolerating normal diet |
| Day 1 | Discharged home the same evening after the procedure |
| Histopathology | Adequate tissue obtained; definitive diagnosis established, resolving the CT’s inconclusive finding |
| 1 Week | Reviewed the confirmed diagnosis with Dr. Rathod and discussed the recommended next steps |
| 1 Month | Appropriate further management initiated based on the confirmed diagnosis |
| 3 Months | Clinically stable, diabetes control improving with ongoing management |
| 12 Months | Continued structured follow-up as per the confirmed diagnosis |
Long-Term Expectations
With a precise, tissue-confirmed diagnosis in place of an inconclusive CT finding, Mrs. Deshmukh’s care team was able to plan the correct next steps without delay. Whatever the underlying diagnosis, early and accurate characterisation of a pancreatic lesion consistently leads to better-informed treatment decisions and outcomes. She will continue structured follow-up with Dr. Rathod, along with ongoing management of her diabetes and periodic reassessment as clinically indicated.
Patient Feedback
“The CT report used words I didn’t understand, and no one could tell us clearly what was going on. Dr. Rathod explained everything patiently and performed a scan that finally gave us a clear answer within the same visit. That certainty meant everything to my family.”
Sunita Deshmukh, 58 | Nashik, Maharashtra
“We had gone from one place to another with an unclear CT report and no answers. Dr. Rathod’s ultrasound endoscopy gave us a definite diagnosis in one sitting. His clarity and calm approach gave our family real peace of mind.”
Mr. Ramesh Deshmukh, Patient’s Husband | Nashik, Maharashtra
