HomeRadioGraphicsVol. 42, No. 5 PreviousNext Gastrointestinal ImagingFree AccessRadioGraphics FundamentalsCross-sectional Imaging of the Duodenum: Spectrum of DiseaseMatheus M. Gomes , Ulysses S. Torres, Anup S. Shetty, Eduardo O. Pacheco, Anderson Azzolini, Flavio M. Bezerra, Gabriella Silva, Natalia N. Gomes, Pedro L. Coelho, Giuseppe D’IppolitoMatheus M. Gomes , Ulysses S. Torres, Anup S. Shetty, Eduardo O. Pacheco, Anderson Azzolini, Flavio M. Bezerra, Gabriella Silva, Natalia N. Gomes, Pedro L. Coelho, Giuseppe D’IppolitoAuthor AffiliationsFrom the Department of Radiology, Universidade Federal de São Paulo (UNIFESP), 800 Napoleão de Barros St, São Paulo, SP, Brazil 04024-000 (M.M.G., E.O.P., A.A., F.M.B., G.S., N.N.G., P.L.C., G.D.); Grupo Fleury, São Paulo, Brazil (U.S.T., G.S.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (A.S.S.).Address correspondence to M.M.G. (e-mail: [email protected]).Matheus M. Gomes Ulysses S. TorresAnup S. ShettyEduardo O. PachecoAnderson AzzoliniFlavio M. BezerraGabriella SilvaNatalia N. GomesPedro L. CoelhoGiuseppe D’IppolitoPublished Online:Aug 5 2022https://doi.org/10.1148/rg.210111MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe full digital presentation is available online.TEACHING POINTS■ The abdomen is one of the most common sites of extrapulmonary tuberculosis, but duodenal involvement accounts for fewer than 2% of cases. This can be partially explained by the inhibitory influence of gastric acid on mycobacteria with a rapid transit time through the duodenum and a relative paucity of lymphoid tissue in this segment as compared to the rest of the gastrointestinal tract.■ The duodenum is the most common site of intramural hematoma of the gastrointestinal tract. As blunt abdominal trauma is the main cause, the duodenal segments most likely to develop mural hematoma related to abrupt avulsion are the third horizontal portion and the duodenojejunal flexure, owing to the lack of mesentery and to fixation by the Treitz ligament, respectively.■ Despite their size, gastrointestinal stromal tumors (GISTs) rarely cause duodenal obstruction or obstructive jaundice, which can be attributed to a predominantly extraluminal growth pattern. At imaging, a malignant GIST appears as a large well-circumscribed mass with a heterogeneously enhancing pattern and may contain necrotic areas, ulceration, and a central cavity with or without an air-fluid level.Although upper gastrointestinal endoscopy plays a well-established role in duodenal evaluation, it allows direct visualization of only the proximal lumen. Cross-sectional imaging modalities (especially CT and MRI) have been increasingly effective in staging duodenal lesions, some of which are incidentally detected and beyond the limits of endoscopic evaluation. The online presentation comprises an extensive and illustrative review of the clinical and radiologic aspects of multiple duodenal conditions, which are classified into five main categories.Infectious and inflammatory causes are tuberculosis, peptic ulcer disease, pancreatic pseudocyst in the duodenal wall, paraduodenal or groove pancreatitis, Crohn disease, cholecystoduodenal fistula (Bouveret syndrome), and Zollinger-Ellison syndrome. Malignant masses are adenocarcinoma, lymphoma, neuroendocrine tumor, and leiomyosarcoma. Benign masses are hamartomatous polyp, lipoma, gastrointestinal stromal tumor, villous adenoma, schwannoma, and gangliocytic paraganglioma. Traumatic and vascular causes are hematoma, aortoenteric fistula, superior mesenteric artery syndrome, and Henoch-Schönlein purpura. Anatomic causes are bulging papilla, heterotopic pancreas, intussusception, duplication cyst, and Lemmel syndrome.Correlation of cross-sectional imaging findings with endoscopic findings is included in the online presentation when available. Understanding the anatomic features of each duodenal portion can also aid in diagnosis. Examples include peptic ulcer disease in the first portion of the duodenum due to the proximity to gastric acid (Fig 1), pancreatic pseudocyst in the second portion of the duodenum in proximity to the pancreatic parenchyma (Fig 2), and Crohn disease involving the fourth portion of the duodenum in conjunction with a proximal jejunal stricture.Figure 1. Penetrating peptic duodenal ulcer in a 54-year-old man with acute epigastric pain and hematemesis. Axial CT image reveals inflammatory changes involving the duodenal bulb, including hyperenhancing mucosa, a luminal outpouching with regional fat stranding (arrow), and gastric dilatation (*).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Pancreatic pseudocyst in the duodenal wall in a 42-year-old man with a recent history of acute pancreatitis. Coronal CT image depicts a fluid collection along the duodenal wall (dashed line) and gastric distention (*). Sampling of the fluid collection revealed a high amylase concentration (1200 U/L).Figure 2.Download as PowerPointOpen in Image Viewer Careful imaging assessment of the duodenum that combines clinical and epidemiologic aspects with key imaging features facilitates rapid and accurate diagnosis and treatment.AcknowledgmentThe authors thank Valéria Lira for the commissioned illustrations in the online presentation.Presented as an education exhibit at the 2020 RSNA Annual Meeting.All authors have disclosed no relevant relationships.Suggested ReadingsBarat M, Dohan A, Dautry R, et al. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017;98(10):663–675. Crossref, Medline, Google ScholarFong JK, Poh AC, Tan AG, Taneja R. Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol 2014;203(1):29–36. Crossref, Medline, Google ScholarGosangi B, Rocha TC, Duran-Mendicuti A. Imaging spectrum of duodenal emergencies. 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Link, Google ScholarArticle HistoryReceived: Apr 4 2021Revision requested: Aug 4 2021Revision received: Aug 15 2021Accepted: Aug 16 2021Published online: Aug 05 2022Published in print: Sept 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleCross-sectional Imaging of the Duodenum: Spectrum of Disease05 Aug 2022Default Digital Object SeriesRecommended Articles Fluoroscopic Evaluation of Duodenal DiseasesRadioGraphics2022Volume: 42Issue: 2pp. 397-416Imaging Spectrum of Duodenal EmergenciesRadioGraphics2020Volume: 40Issue: 5pp. 1441-1457Pancreaticoduodenal Groove: Spectrum of Disease and Imaging FeaturesRadioGraphics2022Volume: 42Issue: 4pp. 1062-1080Imaging of Drug-induced Complications in the Gastrointestinal SystemRadioGraphics2016Volume: 36Issue: 1pp. 71-87Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and ComplicationsRadioGraphics2017Volume: 37Issue: 2pp. 484-499See More RSNA Education Exhibits Four parts, Four Patterns: Assessing the Duodenum and Its Conditions from a New PerspectiveDigital Posters2020Imaging Of Acute Gastric ConditionsDigital Posters2020Donât Forget the Duodenum: Imaging Spectrum of Duodenal EmergenciesDigital Posters2019 RSNA Case Collection Duodenal hematomaRSNA Case Collection2021Bouveret SyndromeRSNA Case Collection2022Bouveret syndromeRSNA Case Collection2021 Vol. 42, No. 5 Slide PresentationMetrics Downloaded 2,319 times Altmetric Score PDF download