Computed tomography – an ally of the duodenum in assessing its inside or outside mass-like lesions

Congress:

ECR 2020

Poster Number:

C-09946

Type:

Educational Exhibit

Keywords:

Not applicable, Metastases, Diverticula, Cancer, Biopsy, CT, Small bowel, Gastrointestinal tract, GI Tract

Authors:

M. Badulescu¹, M. D. COMSA²; ¹Cluj Napoca/RO, ²Cluj Napoca, Cl/RO

DOI:

10.26044/ecr2020/C-09946

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-09946

Fig. 1: Neuroendocrine tumor

Fig. 2: Histopathologic examination of the duodeno-pancreatectomy piece

Fig. 3: Gastrointestinal stromal tumor

Learning objectives

To make a brief characterization of the most common or uncommon duodenal masses which can cause luminal narrowing and obstruction. To bring into attention the possibility of duodenal involvement in pancreatic, hepatic or gastric lesions. To assess the importance of computed tomography in depicting duodenal or juxtaduodenal masses, whether they are symptomatic or incidental findings.

Background

Epidemiology and pathogeny of duodenal masses Primary malignant tumors of the duodenum are rare conditions, but they cumulate up to 50% of small bowel malignancies. The most frequent tumor of the duodenum is adenocarcinoma. Other primary tumors are lymphomas, neuroendocrine tumors, stromal tumors [1]. Adenocarcinoma accounts for up to 80—90% of all primary duodenal malignant tumors [2]. It has a peak incidence in the 7th decade and it’s very aggressive, with quick evolution towards metastasis and invasion of the retroperitoneal fat planes or other organs....

Findings and procedure details

Duodenal lesions are primarily diagnosed using videoendoscopy and biopsy, but sometimes this is not enough or there are duodenal conditions that are incidentally discovered with computed tomography. Computed tomography (CT) and magnetic resonance (MR) imaging technology improved other the time their diagnostic capabilities. Therefore, nowadays CT and MRI are used efficiently to evaluate the intraluminal content, duodenal wall, and extraduodenal space. The duodenal masses are completely assessed when CT is associated with optimal duodenal distention and intravenous administration of iodinated contrast material [1,2]. Computed tomography...

Conclusion

Duodenal masses have a great variety and they aren’t so uncommon, therefore it is essential to pay more attention to the duodenum when examining an abdominal CT scan. Computed tomography has great importance in assessing duodenal mass-forming lesions, whether they are intramural or extrinsic and to establish furthermore the patency of the duodenal lumen.

Personal information and conflict of interest

M. Badulescu; Cluj Napoca/RO - nothing to disclose; M. D. Comsa; Cluj Napoca/RO - nothing to disclose.

References

1. Mannick, R. G. (2001). Surgical Treatment - Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt. 2. M. Barat et al. (2017). Mass-forming lesions of the duodenum: a pictorial review. Diagnostic and Interventional Imaging, 663-675. 3. H. Knipe et al.. Duodenal adenocarcinoma. Retrieved from Radiopaedia.org: https://radiopaedia.org/articles/duodenal-adenocarcinoma-2. 4. R. Wang et al.; (2019, October 24). Management of Gastrointestinal Neuroendocrine Tumors. Clin Med Insights Endocrinol Diabetes, pp. 1-12. 5. Carbo et al. Acquired Constricting and Restricting Lesions of the Descending Duodenum. RadioGraphics 2014; 34:1196–1217. 6. Michael P. Federle and Siva...