Gastric Diverticulum

Michael P. Federle, MD, FACR

Key Facts

Imaging

Most (> 75%) are juxtacardiac diverticula
- Near gastroesophageal junction, on posterior aspect of lesser curvature of stomach
Usually 1-3 cm, up to 10 cm in diameter
Barium-filled diverticulum with air-fluid level
CT findings
- Often in suprarenal location (mimics adrenal mass)
- Connection to stomach may be subtle
- Air-filled, fluid-filled, or contrast-filled mass
- No enhancement of contents

Top Differential Diagnoses

Adrenal mass
Ectopic pancreatic tissue
Abdominal abscess

Pathology

Pouch/sac includes 3 normal layers of bowel wall (i.e., mucosa, submucosa, and muscularis propria)

Clinical Issues

Complications (rare)
- Bleeding, ulceration, carcinoma
No treatment needed unless complications

Diagnostic Checklist

Incidental finding that may be mistaken for adrenal mass on CT
- Barium studies or CT in supine and prone position with oral contrast and gas granules will differentiate diverticula from mass

(Left) Upright film from an upper GI series shows a typical gastric diverticulum

with an air-contrast level seen within an outpouching near the gastric cardia. (Right) Axial CECT in the same patient shows a near-water-density mass

projecting posterior to the gastric fundus

. The connection to the stomach is much more difficult to see on CT. Distention of the stomach with oral contrast or gas granules may be required to make the diagnosis on a CT scan.

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