CASE REPORT A case of serous cystadenoma of the pancreas with a central stellate scar detected on contrast-enhanced ultrasound with perflubutane Hirofumi Yamanishi Æ Tomoyuki Yokota Æ Nobuaki Azemoto Æ Masashi Hirooka Æ Hidehiro Murakami Æ Yoichi Hiasa Æ Bunzo Matsuura Æ Morikazu Onji Received: 18 November 2008 / Accepted: 23 February 2009 / Published online: 25 April 2009 Ó Springer 2009 Abstract An asymptomatic 66-year-old woman was admitted to our hospital for detailed evaluation of a 63-mm mass in the tail of the pancreas detected on abdominal computed tomography (CT). Abdominal ultrasound (US) revealed a hypoechoic solid mass, but on contrast- enhanced ultrasound (CE-US) with perflubutane, a stellate structure within the tumor, characteristic of a serous cyst- adenoma, was observed. A distal pancreatectomy was performed, and histologic examination confirmed a serous cystadenoma of the pancreas. This case highlights the usefulness of CE-US with perflubutane for diagnosis of pancreatic serous cystadenomas. Keywords Perflubutane Á Serous cystadenoma Á Contrast-enhanced ultrasound Á Central stellate scar Á Pancreatic tumor Introduction Pancreatic serous cystadenomas were first reported by Compagno et al. [1] in 1978. Serous cystadenomas are relatively rare pancreatic cystic tumors, but the number of reported cases has increased with advances in diagnostic imaging. Abdominal US and endoscopic US are important tools for diagnosis, but the use of CE-US with the new contrast agent perflubutane to detect the characteristic findings of serous cystadenomas has not previously been reported. We report a case in which a central stellate scar, a characteristic finding of pancreatic serous cystadenomas, was not visualized on other imaging studies, yet was clearly detected on CE-US with perflubutane. This case is reported to demonstrate the usefulness of CE-US with perflubutane to diagnose pancreatic serous cystadenomas. Case report Patient: A 66-year-old woman. Chief complaint: None (admitted for detailed evaluation of a mass lesion in the tail of the pancreas). Family history: Unremarkable. Past medical history: Unremarkable. Lifestyle habits: No smoking; social drinking. History of present illness: The patient was being treated by a local physician for hypertension. Since a screening abdominal US showed thickening of the gallbladder wall, she was referred to our outpatient department for further evaluation. Abdominal CT of the gallbladder showed adenomyosis, but a 63-mm cystic lesion was also noted in the tail of the pancreas. She was admitted to the hospital for further evaluation. Findings on admission: Height 146 cm, weight 57.4 kg, blood pressure 124/76 mmHg, pulse 72/min, and tempera- ture 36.8°C. There was no conjunctival pallor or scleral icterus. Heart and breath sounds were normal. The abdomen was flat, soft, and nontender, and no masses were palpable. Laboratory tests on admission: Hematology, clinical chemistry, and pancreatic enzyme values were normal. H. Yamanishi Á T. Yokota Á N. Azemoto Á Y. Hiasa Á B. Matsuura Á M. Onji (&) Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan e-mail: onjimori@m.ehime-u.ac.jp M. Hirooka Á H. Murakami Department of Endoscopic Medicine, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan 123 Clin J Gastroenterol (2009) 2:232–237 DOI 10.1007/s12328-009-0078-8