6.

DIAGNOSTIC RADIOLOGY – PATHOLOGIC FINDINGS IN THE IMAGING

OF GIT (STOMACH, SMALL INTESTINE, AND LARGE INTESTINE)

Stomach
i. carcinoma
- irregular filling defect with alteration of normal
mucosal pattern
- may show obstruction at esophagus (if tumor at
fundus) or gastric outlet (if tumor in antrum)
- if whole stomach involved = thick rigid tube, lacking
peristalsis with mucosal fold obliteration
- rapid gastric emptying (cardia and pylorus are held
open due to rigidity)

ii. malignant lymphoma

- generalized thickening of mucosal folds

iii. leiomyoma
- smooth, round filling defect arising from stomach wall
(submucosal tumor)
- have large extraluminal extension (easily recognizable
in CT)

iv. polyps
- single, multiple; sessile, with stalk
- need biopsy to distinguish whether it is benign or malignant

v. gastric ulcer (pic on right)

- benign or malignant  gastroscopy

vi. gastritis
- erosion demonstrated by barium
- now diagnosed endoscopically!

vii. hiatus hernia

- herniation of stomach into mediastinum thru
esophageal hiatus in diaphragm
- sliding hernia –more common; stomach portion situated above diaphragm  reflux
occur (cardiac sphincter incompetent)  esophagitis, ulcer, peptic stricture

- rolling hernia (para-esophageal) – fundus

herniated but esophagogastric junction remains
competent below diaphragm <upside-down
stomach>

Small intestine
i. narrowing
- normal: by peristaltic wave
- due to Chron’s disease (common), tuberculosis, lymphoma
- doesn’t contain normal mucosal folds, result in dilation of bowel proximally

ii. ulceration
- appear as spikes ^ ^ projecting outward
- either shallow, deep
- due to Chron’s disease (common), tuberculosis, lymphoma
- ‘cobblestone’ appearance = ulceration + mucosal
edema

iii. Chron’s disease (pic)

- non- specific granulomatous inflammation
- always effect terminal ileum (skip lesions!)
- show strictures and mucosal abnormality;
‘cobblestone’ appearance
- fistula may occur to other small bowel loops, colon,
bladder, vagina
- US can identify thickened loop, abscess collections

v. gluten-sensitive enteropathy
- autoimmune disorder of the small intestine caused by
gluten intolerance in genetically predisposed individuals
- chronic disease characterized by mucosal lesions of the
small bowel that impair nutrient absorption
- colonization of jejunum; jejunization of ileum (pic)

vi. worm infestation

- by roundworm (Ascaris)
- filling defects in lumen of bowel
vii. carcinoid (pic)
- bowel obstruction
- smooth submucosal mass in the mid jejunum eccentrically placed
- proximal small-bowel dilatation
- angulation of the bowel and kinking of the jejunum at the site of the submucosal mass.

iv. lymphoma
- small mucosal filling defects due to tumor nodules
- displacement of loops due to enlarged lymph nodes
- CT show thickening of bowel wall due to lymphomatous infiltration; deep mucosal and
intramural ulcerations; mesenteric lymphadenopathy

Colon
i. diverticulosis (colonic outpouchings)
- multiple saclike mucosal herniations through weak points
in the intestinal wall

ii. diverticulitis
- developed from i.

iii.ulcerative colitis
(Chron’s disease refer
above)
- IBD (inflamm bowel
disease)
- granular mucosa
- rigid, tubular colon

iv. tumor
- adenomatous polyposis (genetic) -pic
- filling defect due to polyps
Prepared by: Lene 