Endoscopic ultrasound in chronic liver disease

Figure 1 Endoscopic ultrasound in the diagnosis of obstructive jaundice. An 80-year-old male with a history of non-alcoholic fatty liver disease presented with new onset of painless jaundice, physical examination consistent with Courvoisier’s sign (palpable gallbladder), and laboratory test results suggestive of severe biliary obstruction. A: Distended gallbladder (arrow) seen on computed tomography, sagittal view. B: Distended gallbladder seen on endoscopic ultrasound. C: Double duct sign consisting of a dilated common bile duct (CBD) and dilated pancreatic duct. D: A poorly-marginated, hypoechoic pancreatic mass (asterisk) invading the distal CBD. E: Fine-needle biopsy of the pancreatic mass (asterisk), which led to tissue diagnosis of adenocarcinoma and facilitated subsequent management. GB: Gallbladder; PD: Pancreatic duct; CBD: Common bile duct.