This work aims at demonstration the role of spiral CT and endoscopic ultrasonography in early diagnosis and mangement of Periampullary tumors.It includes the diagnostic techniques and diagnostic features of both spiral CT and EUS. Illustrative cases are presented and suggested protocols for work up in such cases is included. Twenty patients with periampullary tumors were selected to be included in this study as illustrative cases for spiral CT and EUS features in pancreatic neoplasms. All cases were subjected to clinical examination, laboratory findings, abdominal ultrasound, Spiral CT, ERCP, Endoscopic ultrasonography and operative interference. Spiral CT has dramatically early diagnosis of small pancreatic tumors, small liver deposits, lymph nodes, vascular and bowel invasions. Also EUS has more accuracy and sensitivity in detecting very small periampullary tumors, vascular invasions and lymph nodes around the tumors. Surgical findings were the gold standard for assessing the sensitivity of spiral CT and EUS for estimating resectability of periampullary tumors or unresectability.