Chapter Outline
- Table 36-1.
- Table 36-2.
- Table 36-3.
- Table 36-4.
- Table 36-5.
- Table 36-6.
- Table 36-7.
- Table 36-8.
Dilated Duodenum (Megaduodenum)
- Table 36-9.
TABLE 36-1
Cause | Location | Comments |
---|---|---|
EROSIONS | ||
Idiopathic | Antrum or body; often aligned on rugal folds | Varioliform erosions |
Aspirin or other nonsteroidal anti-inflammatory drugs | Antrum or body; may be on or near greater curvature | Varioliform, linear, or serpiginous erosions |
Crohn’s disease | Antrum or body | Associated Crohn’s disease in small bowel or colon |
ULCERS | ||
Helicobacter pylori | Usually on lesser curvature or posterior wall of antrum or body | Accounts for 70%-80% of gastric ulcers |
Aspirin or other nonsteroidal anti-inflammatory drugs | Distal half of greater curvature | May simulate malignant ulcer |
Gastritis | Variable | Hypertrophic gastritis, granulomatous conditions, radiation, caustic ingestion, infections |
Zollinger-Ellison syndrome | Variable | Associated ulcers in atypical locations; hypergastrinemia |
Early gastric cancer | Variable | Nodular or deformed folds surrounding ulcer |
TABLE 36-2
Cause | Radiographic Findings | Comments |
---|---|---|
BENIGN MUCOSAL LESIONS | ||
Hyperplastic polyps | Round sessile polyps in fundus or body; usually multiple | Not premalignant |
Adenomatous polyps | Lobulated or pedunculated polyps in antrum; often solitary | Premalignant |
Polyposis syndromes | Multiple polyps in stomach (also in small bowel or colon) | Familial adenomatosis polyposis, Peutz-Jeghers syndrome, Cronkhite-Canada syndrome, juvenile polyposis, Cowden’s disease |
Villous tumor | Giant mass with soap bubble appearance | Premalignant; rare in stomach |
Bezoar | Giant masslike filling defect; freely movable | Unusual eating habits; gastroparesis or gastric outlet obstruction |
MALIGNANT MUCOSAL LESIONS | ||
Carcinoma | Polypoid mass; ulceration common | Usually advanced gastric cancer but may occasionally be early cancer |
BENIGN SUBMUCOSAL LESIONS | ||
Benign gastrointestinal stromal tumor | Smooth submucosal mass; ulceration common; rarely multiple | May be difficult to differentiate from malignant gastrointestinal stromal tumor |
Leiomyoblastoma | Smooth submucosal mass; ulceration common | Risk of malignancy |
Lipoma | Submucosal mass with changeable shape at fluoroscopy; fat density on CT | Usually asymptomatic |
Hemangioma | Submucosal mass with phleboliths | Risk of massive gastrointestinal bleeding |
Lymphangioma | Submucosal mass | Rare |
Glomus tumor | Submucosal mass | Usually asymptomatic |
Neurofibroma | Solitary or multiple submucosal masses | Von Recklinghausen’s disease |
Granular cell tumor | Solitary or multiple submucosal masses | Associated lesions on skin or tongue |
Inflammatory fibroid polyp | Sessile or pedunculated polyp in antrum; usually solitary | Usually asymptomatic |
Ectopic pancreatic rest | Submucosal mass with central umbilication; usually on greater curvature of distal antrum | Usually asymptomatic |
Duplication cyst | Submucosal mass on greater curvature of antrum or body; rarely communicates with lumen | Usually asymptomatic during first year of life |
Varices | Multiple submucosal masses in fundus (likened to a bunch of grapes) | Portal hypertension or splenic vein obstruction |
MALIGNANT SUBMUCOSAL LESIONS | ||
Malignant gastrointestinal stromal tumor | Solitary, lobulated submucosal mass; ulceration or cavitation common | Better prognosis than carcinoma |
Metastases | One or more submucosal masses; ulceration or cavitation common; bull’s-eye lesions of varying sizes | Most commonly malignant melanoma or metastatic breast cancer |
Lymphoma | One or more submucosal masses; ulceration or cavitation common; bull’s-eye lesions of varying sizes | Usually non-Hodgkin’s lymphoma |
Kaposi’s sarcoma | Multiple submucosal masses or bull’s-eye lesions | Homosexuals with AIDS; usually have Kaposi’s sarcoma on skin |
Carcinoid | Multiple submucosal masses or bull’s-eye lesions | Carcinoid syndrome uncommon |
Leukemia | Multiple submucosal masses or polyps | Rare |
Multiple myeloma | Multiple submucosal masses | Rare |
TABLE 36-3
Cause | Distribution | Comments |
---|---|---|
BENIGN CONDITIONS | ||
Antral gastritis | Antrum | Epigastric pain or dyspepsia |
Helicobacter pylori gastritis | Usually antrum or antrum and body; sometimes diffuse | Associated with peptic ulcer disease |
Hypertrophic gastritis | Fundus and body | Increased acid secretion; frequent duodenal ulcers |
Ménétrier’s disease | Fundus and body (massive folds) | Hypochlorhydria and hypoproteinemia |
Zollinger-Ellison syndrome | Fundus and body (increased secretions; ulcers common) | Hypergastrinemia resulting from non-beta islet cell tumors |
Varices | Fundus and cardia (serpentine folds) | Portal hypertension or splenic vein obstruction |
Eosinophilic gastritis | Antrum | Peripheral eosinophilia; history of allergic diseases |
Crohn’s disease | Antrum and body | Associated Crohn’s disease in small bowel or colon |
Sarcoidosis | Antrum | Pulmonary sarcoidosis |
Tuberculosis | Antrum | History of AIDS or travel to endemic areas |
Caustic ingestion | Antrum | History of caustic ingestion |
Radiation | Antrum | History of radiation therapy (>50 Gy) |
Floxuridine toxicity | Antrum and body | Hepatic artery infusion chemotherapy |
Amyloidosis | Antrum | Systemic amyloidosis |
MALIGNANT CONDITIONS | ||
Lymphoma | Localized or diffuse | May have generalized lymphoma |
Carcinoma | Localized or diffuse | Associated narrowing and rigidity of stomach |