CT of duodenal pathology
R Zissin, MD1,
A Osadchy, MD1,
G Gayer, MD2 and
M Shapiro-Feinberg, MD1
1Department of Diagnostic Imaging, Sapir Medical Center, Kfar Saba 44281 and 2Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Figure 1. Non-rotation type intestinal malrotation. Contrast enhanced CT at the level of the pancreatic head showing right-sided contrast-filled small bowel loops (arrows), left-sided colon (c) and absence of the horizontal duodenum. Note an abnormal relationship of the superior mesenteric vessels (open arrow) as well as aplasia of the uncinate process of the pancreas (arrowhead).
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Figure 2. Type IIc intestinal malrotation in a 49-year-old man with chronic abdominal pain. The horizontal duodenum passes anteriorly to the vertically oriented superior mesenteric vessels (arrowhead), with a normally located colon (c) in front of it. (Reprinted, with permission, from Abdom Imaging [1]).
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Figure 3. Contrast enhanced CT shows a cystic mass in the medial portion of the descending duodenum (arrow), which proved to be a duplication cyst.
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Figure 4. Duodenal diverticulum. A rounded collection of orally digested contrast medium with an air–fluid level (D.D) is connected by a thin neck (small arrow) to the medial aspect of the duodenal loop.
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Figure 5. Contrast enhanced CT of a 77-year-old man with acute abdomen shows free peritoneal fluid and air (small arrows) and irregular mural thickening of the proximal duodenum (arrow) owing to perforated ulcer disease.
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Figure 6. Marked asymmetric mural thickening of the medial aspect of the proximal duodenum with an ulcer crater (arrow) in a patient with peptic ulceration.
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Figure 7. Contrast enhanced CT of a 52-year-old man with Crohn's disease shows mural thickening ofthe horizontal portion of the duodenum, with a tubular stricture causing a pre-stenotic dilatation. Note the slightly enlarged mesenteric nodes.
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Figure 8. Contrast enhanced CT of a 38-year-old woman with acute cholecystitis shows a distended gall bladder with marked mural thickening and thickening of the adjacent duodenum wall (arrows).
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Figure 9. Lipoma. An intraluminal filling defect within the duodenum with low attenuation values of fat density (arrow).
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Figure 10. A 45-year-old man with Gardner's syndrome presented with jaundice. A small polypoid lesion of soft tissue density (arrow) at the medial aspect of the descending duodenum, the level of the ampulla of Vater, proved to be adenocarcinoma. Note the hydronephrotic right kidney.
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Figure 11. Adenocarcinoma of the descending duodenum seen as circumferential thickening of the duodenal wall.
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Figure 12. Leiomyosarcoma. Contrast enhanced CT of a 48-year-old man with a necrotic extramural mass arising from the medial wall of the descending duodenum (D).
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Figure 13. Contrast enhanced CT of a 44-year-old man. A large extramural mass with a hypodense component in the distal portion of the horizontal duodenum proved to be lymphoma. The tumour narrows the duodenal lumen (arrows) with proximal dilatation.
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Figure 14. Contrast enhanced CT of a 57-year-old-woman with abdominal pain and vomiting. Irregular mural thickening at the ligament of Treitz with aneurysmal dilatation and ulceration (U) was due to lymphoma.
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Figure 15. Contrast enhanced CT of a 51-year-old man with a large necrotic carcinoma of the pancreatic head shows duodenal invasion as marked circumferencial mural thickening.
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Figure 16. Contrast enhanced CT of a 57-year-old man shows a large tumour of the ascending colon with direct extension (arrow) to the duodenum.
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Figure 17. Afferent loop syndrome. Contrast enhanced CT of the upper abdomen shows a U-shaped tubular structure filled with fluid and identifiable valvulaeconniventes (small arrows). In addition, CT findings of intestinal non-rotation are seen. C, colon; large arrows, small bowel loops.
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Figure 18. A 19-year-old man following blunt abdominal trauma. A large intramural duodenal haematoma with characteristic mixed attenuation. Fluid, probably blood (arrow), is also present in the right anterior pararenal space.
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Figure 19. Trichobezoar. CT of a 14-year-old girl with epigastric pain and anaemia. A large intraluminal heterogeneousmass, with mottled gas within the stomachand third part of the duodenum, surrounded by oral contrast medium.
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Copyright © 2002 by the British Institute of Radiology.
