RADIOLOGY CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG

1. 63Duodenal 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 63-1 Normal duodenum. Contrast scan obtained
with oral administration of whole milk and the patient
in the right posterior oblique position shows the
lumen, mural enhancement, and the gastroduodenal
artery.80

4. • Fig GI 63-2 Diverticulum. Contrast scan shows
two “duodenal lumina,” with the true lumen
lateral to the diverticulum (straight arrow). The
diverticulum contains an air-fluid level and causes
medial displacement of the pancreatic head
(curved arrow).80

5. • Fig GI 63-3 Duplication. Scan without oral
contrast shows two fluid-attenuation structures
in the second portion of the duodenum. The
duplicated segment (curved arrow) is medial to
the true lumen and contains debris. The true
lumen is narrowed (straight arrow).80

6. Fig GI 63-4 Annular pancreas. A band of ectopic pancreatic tissue
is seen posterior to the second portion of the duodenum
(arrow).80

7. • Fig GI 63-5 Ruptured duodenum (motor
vehicle accident). There is fluid in the
duodenum and leakage of fluid into the right
anterior pararenal space (arrow).80

8. Fig GI 63-6 Duodenal perforation (endoscopy). Thick-walled,
contracted duodenum with gas in the adjacent retroperitoneum
(arrow).80

9. • Fig GI 63-7 Pancreatitis. Extensive stranding of the
peripancreatic fat indicates pancreatitis. Intramural
hemorrhage has caused massive enlargement of the
lateral duodenal wall, accompanied by a focal area of
increased attenuation at the site of bleeding (black
arrow). The duodenal lumen, which contains low-
attenuation fluid, is narrowed and displaced medially
(white arrow).80

10. • Fig GI 63-8 Perforated ulcer. Intraperitoneal
extravasation of oral contrast material from the lateral
portion of the duodenum (white arrow) and leakage of
contrast around the liver (black arrow).

11. • Fig GI 63-9 Gastric outlet obstruction
(duodenal ulcer). Dilated stomach and
thickened wall of the duodenal bulb,
associated with stranding of the periduodenal
fat (arrow).80

12. • Fig GI 63-10 Gallstone ileus. Gallstone within
the duodenum (arrow) with proximal
duodenal and gastric dilatation.80

13. • Fig GI 63-11 Henoch-Schonlein purpura.
Marked thickening of the second and fourth
portions of the duodenal wall (arrows). The
lumen was narrowed, but there was no
obstruction of the gastric outlet.80

14. • Fig GI 63-12 Lipoma. Low-attenuation lesion
with well-circumscribed margins (arrow).80

15. • Fig GI 63-13 Villous adenoma. Soft-tissue mass
(white arrow) arising from the medial wall of
the duodenum. The duodenal lumen is
narrowed (black arrow).80

16. • Fig GI 63-14 Peutz-Jeghers syndrome. Soft-
tissue filling defect in the duodenal lumen
(arrow), outlined by water. There were several
polyps in the proximal small bowel.80

17. • Fig GI 63-15 Adenocarcinoma. A solid
intraluminal soft-tissue mass (arrow) without
transmural invasion or retroperitoneal
adenopathy.80

18. • Fig GI 63-16 Paraganglioma. Subtle, smoothly
marginated soft-tissue mass (arrows) in the
second and third portions of the duodenum.80

19. • Fig GI 63-17 Metastasis (colon cancer). Mass of
soft-tissue attenuation that causes lateral
displacement of the duodenum (arrow). The
lesion mimics a mass arising in the duodenum or
pancreatic head.80