RADIOLOGY CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG

1. 62Gastric Diseases on Computed
Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 62-1 Early gastric carcinoma. Coronal
reformatted image shows an elevated lesion in the
greater curvature that protrudes less than 5 mm into
the lumen. There is marked focal enhancement of the
inner layer of the gastric wall (arrows).77

4. • Fig GI 62-2 Antral carcinoma. Coronal reformatted image
shows focal wall thickening of the antrum with marked
enhancement of the mucosal layer (arrows). The subtle
irregularities of the mucosal surface corresponded to ulcers
at histology. Note the clear fat plane around the tumor.77

5. • Fig GI 62-3 Advanced gastric carcinoma. Large
ulcerating mass with spread of tumor beyond
the gastric wall. There is evidence of
adenopathy in the celiac nodal chain.78

6. Fig GI 62-4 Advanced gastric carcinoma. Large, ulcerating exophytic
mass with liver metastases. The tumor appears to involve the
pancreas.78

7. • Fig GI 62-5 Linitus plastica. Oblique coronal
reformatted image shows circumferential
thickening of the wall of the stomach with loss of
gastric folds. The tumor extends into the distal
esophagus (arrow).77

8. Fig GI 62-6 Lymphoma. Large areas of gastric wall thickening
(arrows) with enlarged lymph nodes (arrowhead).77

9. • Fig GI 62-7 Lymphoma. Marked thickening of
gastric folds with extensive adenopathy and
ascites.78

10. • Fig GI 62-8 Metastasis. Submucosal gastric
masses from a primary esophageal
carcinoma.77

11. • Fig GI 62-9 Metastasis. Direct infiltration of
the stomach by an esophageal carcinoma
(arrows).77

12. • Fig GI 62-10 Gastrointestinal stromal tumor. Oblique
coronal reformatted image shows a large,
inhomogeneous, round mass that compresses the
fundus of the stomach. Note the obtuse angle on the
medial side and the rounded angle on the lateral side,
which are compatible with the subserosal location seen
at histology.77

13. • Fig GI 62-11 Leiomyoma. Smooth ulcerating
mass in the fundus of the stomach.78

14. • Fig GI 62-12 Leiomyosarcoma. Huge gastric mass
that invades the spleen and left kidney. The
tumor extends downward to invade the left psoas
muscle as well.78

15. • Fig GI 62-13 Schwannoma. A submucosal soft-
tissue mass with only minor enhancement but
with markedly enhancing intact mucosa. Note
that the perigastric fat plane around the tumor is
clear.77

16. • Fig GI 62-14 Gastric polyps. (A) Hypertrophic
polyps appear as multiple small nodular
masses arising from the gastric wall (arrows).
(B) Adenomatous polyp appears as a single
larger lesion in the gastric antrum (arrow).77

17. Fig GI 62-15 Helicobacter pylori-induced gastritis. Focal
thickening and enhancement of the gastric wall (arrows). Note
the preserved mucosal lining.77

18. • Fig GI 62-16 Gastric ulcer. (A) Axial image shows focal
asymmetric thickening (arrow) of the wall of the gastric
antrum with barium trapped in the ulcer cavity
(arrowhead).79 (B) Coronal reformatted image in
another patient shows mucosal hyperemia and wall
thickening in the antrum with a central ulcer (arrow).77

19. • Fig GI 62-17 Radiation gastritis. Thickening and
narrowing of the gastric antrum (arrows), which
correspond to the postoperative radiation ports
in a woman who had undergone a Whipple
procedure for pancreatic cancer.78

20. • Fig GI 62-18 Eosinophilic gastritis. (A, B) Thickening of the
gastric antrum and dilated loops of proximal small bowel.
Note the “wet” appearance of the small bowel folds and
minimal fluid in the mesentery.78

21. Fig GI 62-19 Ménétrier's disease. Large, lobulated folds with
preserved gastric mucosa that primarily involve the fundus.77

22. • Fig GI 62-20 Emphysematous gastritis. Gas in the
gastric wall (arrow) that is best seen posteriorly.
Endoscopy demonstrated massive infarction of
the entire posterior wall of the stomach.78

23. • Fig GI 62-21 Gastric emphysema. Gas in the
gastric wall without evidence of perforation or
extravasation of contrast material. The changes
were thought to be due to placement of a
gastrotomy tube, and the patient recovered with
conservative treatment.78

24. • Fig GI 62-22 Gastric outlet obstruction.
Coronal reformatted image shows distal
stomach obstruction due to infiltration by a
cholangiocarcinoma (arrow). Note the dilated
intrahepatic bile ducts (arrowheads).77

25. • Fig GI 62-23 Gastric varices. Coronal
reformatted image shows varices of the small
gastric veins in a patient with chronic
pancreatitis and obstruction of the splenic
vein.

26. • Fig GI 62-24 Hiatal hernia. Focal asymmetric
thickening (arrow) of the posteromedial wall of
the gastric fundus in the region of the cardia with
no evidence of enhancement.79

27. • Fig GI 62-25 Cytomegalovirus infection (acquired
immunodeficiency syndrome). Ulceration in the
gastric antrum with thickened folds suspicious for
a neoplasm (arrow).78