Bedside Endoscopic Ultrasound in Critically Ill patients

Table 1

EUS findings, final diagnoses, and outcomes of the patients.

Patient	Age/gender	Indication for EUS	EUS finding	Number of passes (FNA)	On-site cytologist available	Cytological finding	Final diagnosis	Impact of EUS on management	Patient’s outcome
1	74/F	Suspected pancreatic mass on CT	Solid-cystic mass at BOP	3	Yes	Acute inflammation^a	Necrotizing pancreatitis & pancreatic abscess	Yes	Died*
2	66/M	Suspected pancreatic mass on CT	Heterogenous mass in retroperitoneum	4	Yes	Suspicious for lymphoma	Systemic Amyloidosis & hemorrhagic pancreatic pseudocyst	No	Died^†
3	50/M	Suspected CBD stone	No CBD stone	NA	N/A	NA	UTI & Sepsis	Yes	Alive
4	50/F	Suspected gastric mass	Focal thickening of gastric mucosa (no tumor)	3	No	Benign epithelium	Severe Pancreatitis^b	Yes	Died^†
5	72/M	Suspected extrahepatic cholestasis	No CBD tumor or stone	NA	N/A	NA	Liver failure^c	Yes	Died*
6	76/M	Mediastinal LN on CT	Subcarinal LN	5	No	Reactive LN	Severe pneumonia	Yes	Died*
7	54/M	Evaluating gastric varices	Thrombosed gastric varices	NA	N/A	NA	Gastric variceal bleeding^d	Yes	Alive
8	52/M	Suspected pelvic abscess	Post-surgical cyst	2	No	Hypocellular sample^e	Hemorrhagic pancreatitis & sepsis	Yes	Died^†
9	61/F	Enlarging pancreatic mass	Large portahepatis LN^f	3	No	Reactive LN	Respiratory failure due to pneumonia	Yes^g	Alive
10	37/F	Mediastinal mass on CT	Mediastinal mass	3	Yes	Nonsmall cell carcinoma	NSCLC with mediastinal involvement	Yes	Died*
11	43/M	Mediastinal adenopathy on CT	Paraesophageal LN	6	Yes	Adenocarcinoma	Metastatic adenocarcinoma	Yes	Died*
12	58/M	Mediastinal mass on CT	Mediastinal mass	4	Yes	SCC	NSCLC	Yes	Died^†
13	76/M	Mediastinal adenopathy on CT	Pleural effusion; celiac & perigastric LN	7	Yes	Non-Hodgkin’s lymphoma	Non-Hodgkin’s lymphoma	Yes	Died^†
14	28/F	Mediastinal adenopathy on CT	Mediastinal mass	5	Yes	Necrosis	Histoplasmosis	No	Alive
15	67/F	Mediastinal mass on CT	LN in aortopulmonary window	4	Yes	Small cell carcinoma	Small cell lung cancer	Yes	Died^†

Abbreviations: BOP: body of pancreas; CBD: common bile duct; NA: not applicable; UTI: urinary tract infection; LN: lymph node; NSCLC: nonsmall cell carcinoma; SCC: squamous cell carcinoma.
*Died a few months after discharge from ICU.
^†Died while was in ICU.
^aEnterococcus grew on culture of fine needle aspirate demonstrating pancreas abscess.
^bPatient’s final diagnosis was severe pancreatitis of allograft pancreas, superior mesenteric vein and superior mesenteric artery thromboses, and abdominal compartment syndrome.
^cLiver failure due to alcoholic cirrhosis.
^dPatient had gastric variceal bleeding due to alcoholic cirrhosis. He underwent EUS for possible EUS-guided injection of cyanoacrylate, but the varices were found thrombosed from the cyanoacrylate injection one week before.
^eCulture of fine needle aspirate was negative. Autopsy showed no pelvic abscess.
^fVery large portahepatis LN with heterogeneous echotexture suggestive of recent bleeding.
^gEUS-FNA had significant impact on the patient management through excluding malignancy.