Stomach and Duodenum: Differential Diagnosis







TABLE 36-1

Gastric Ulcers (No Mass)
















































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

Gastric Mass Lesions


























































































































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

Thickened Gastric Folds












































































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

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Jun 23, 2019 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Stomach and Duodenum: Differential Diagnosis
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