Journal of Medical Ultrasonics

, Volume 45, Issue 1, pp 161–165 | Cite as

A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance

  • Kosuke Minaga
  • Mamoru TakenakaEmail author
  • Shunsuke Omoto
  • Takeshi Miyata
  • Ken Kamata
  • Kentaro Yamao
  • Hajime Imai
  • Tomohiro Watanabe
  • Masayuki Kitano
  • Masatoshi Kudo
Case Report


We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.


Acute necrotizing pancreatitis Bile ducts Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Sonazoid 


Compliance with ethical standards

Conflict of interest

Kosuke Minaga, Mamoru Takenaka, Shunsuke Omoto, Takeshi Miyata, Ken Kamata, Kentaro Yamao, Hajime Imai, Tomohiro Watanabe, Masayuki Kitano, and Masatoshi Kudo declare that they have no conflict of interest.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from the patient for being included in the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2017

Authors and Affiliations

  • Kosuke Minaga
    • 1
  • Mamoru Takenaka
    • 1
    Email author
  • Shunsuke Omoto
    • 1
  • Takeshi Miyata
    • 1
  • Ken Kamata
    • 1
  • Kentaro Yamao
    • 1
  • Hajime Imai
    • 1
  • Tomohiro Watanabe
    • 1
  • Masayuki Kitano
    • 2
  • Masatoshi Kudo
    • 1
  1. 1.Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka-SayamaJapan
  2. 2.Second Department of Internal MedicineWakayama Medical University School of MedicineWakayamaJapan

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