EUS characteristics of celiac ganglia with cytologic and histologic confirmation

Background: Celiac ganglia have not been previously identified by EUS. Objective: To assess whether celiac ganglia can be detected by EUS and to define their characteristics. Design: Retrospective review followed by prospective study. Methods: Retrospective characterization was performed of all celiac ganglia that were incidentally identified by EUS-guided FNA or tru-cut needle biopsy from January 2004 to October 2005. We also prospectively assessed if these structures could be visualized in consecutive patients undergoing curved linear-array EUS. Patients: Seven patients with celiac ganglia diagnosed by EUS-guided FNA (n = 7) and/or tru-cut needle biopsy (n = 1) were reviewed. Twenty-two patients were prospectively evaluated by curved-linear-array EUS. Settings: Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics. Iowa City Iowa, USA. Main Outcome Measurements: EUS features and detection rate of celiac ganglia. Results: All retrospectively evaluated celiac ganglia were identified anterior to the aorta, slightly to the left, and cephalad to the celiac artery take-off, and medial to the left adrenal gland. The mean distance from the celiac artery take-off was 10 mm ( 3 rum); mean size was 13 min ( 3 mm) by 6 min ( 2 min). They appeared as hypoechoic and multilobulated structures with hyperechoic strands. Celiac ganglia with sonographic features as described above were identified in 16 of 22 prospectively evaluated patients (73%). Limitations: Small number of patients; no tissue confirmation of prospectively evaluated patients. Conclusions: Celiac ganglia can be identified with curved linear-array EUS in the majority of patients. Their typical EUS appearance allows distinction from celiac lymph nodes.