EUS with FNA

Just a quick history of problem, I am 44 yo female with 3 mo history of upper left back pain at night. So bad it wakes me up. I have found laying on my left side makes it even worse. It used to go away totally during the day. (No history of back injury). I do not drink alcohol (Less than 4 oz per year!) All test neg for any gallbladder problems. CT scan and MRCP showed single pancreatic lesion approx 2cms. MRCP said cystic lesion and very unlikely pseudocyst.

Three days ago had a EUS FNA with bloody aspirate of lesion. CEA 28. Bx negative. Pain has been worse since the EUS. I had to lay on my left side, and I woke up with horrible pain. Pain is through left epigastric area to mid left back. It is dull but sharp stings of pain at times. I rate it a constant 5/10 with sharp tinges as high as a 10/10. I had IV levaquin and I am also taking levoquin pills for 5 days. No fever.

The doc said the base of the lesion is very irregular and gave me a picture of it.

My question: What does bloody aspirate suggest? Is the CEA accurate when mixed with blood? Any ideas on why the pain is worse? I do not think I am bleeding inside (no hard areas felt).

Thank you for your time and help.

[Kevin Pho, MD]

I agree with the testing thus far, and it has been pretty comprehensive.  

The bloody aspirate is a non-specific finding, and a variety of conditions can lead to this.  The CEA test should not be affected by the blood in the FNA.  In addition to pancreatic issues, a rise in CEA can be indicative of colon cancer.  So, if this is suspected, a colonoscopy should be performed.

I cannot speculate as to the cause of the pain without examination.   Further evaluation can be done with an abdominal MRI, which can better visualize the pancreas.  

These options can be discussed with your personal GI physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd