Dear editor, Pancreatic carcinoma is highly malignant and is mainly characterized by a low rate of eligibility for curative-intent resection,rapid metastases and/or local relapses even after surgery.[1-3]Imaging examinations like enhanced computed tomography(CT)/magnetic resonance imaging(MRI),and positron emission tomography-computed tomography(PET-CT),play an important role in detecting tumor recurrence or residual after radical resection of pancreatic cancer.However,these detection platforms are increasingly reported to have insufficient sensitivity and specificity.[4,5]Here we report a pancreatic cancer patient who had progressively increased carbohydrate antigen 19-9(CA199)level one year and three months after surgery;however,none of the above imaging methods were able to identify the cause.After our investigations,we discovered mediastinal metastasis using endoscopic ultrasonography(EUS)and confirmed by EUS-guided fine needle aspiration(EUS-FNA).