Stomach

Thickened Gastric Wall

  • Gastric wall thickening = wall thickness > 5mm

  • DDx

    • Gastritis

      • Common with many causes

      • Emphysematous gastritis

        • Life threatening

        • Invasion of gastric wall by E. coli or staph aureus

        • Will see air in gastric wall

    • Malignancy (gastric carcinoma, lymphoma)

GISTs

  • Arise from Cajal cells

  • Stomach & Small bowel, rare elsewhere

  • 10% malignant

    • ↑ risk if arise outside of stomach

  • > 40 yo

  • Stain positive for KIT (CD117)

    • Differentiates from leiomyoma/sarcoma

  • Grow away from lumen extending to abdominal cavity

Zollinger-Ellison Syndrome

  • Gastrin producing islet cells of pancreas (gastrinoma)

  • Multiple stomach and duodenal ulcers

  • Findings

    • Hypervascular pancreatic mass

      • Arterially enhancing

References:

Gastric Adenocarcinoma

  • 95% of gastric cancers

  • RF

    • Pernicious anemia

    • Mentrier disease

    • FAP

    • Chronic gastritis

  • Spreads to celiac and gastrohepatic nodes

  • Spreads to liver > lungs > adrenal glands

  • Linitis plastica (scirrhous carcinoma)

    • Diffuse gastric thickening with resultant small gastric lumen

Gastric Lymphoma

  • Most commonly NHL-B cell type

  • Findings favoring Lymphoma > carcinoma

    • Wall thickening > 3 cm

    • Involvement of other parts of GI tract

    • Sub-renal adenopathy

  • Rarely has gastric luminal narrowing