CECT: Mural thickening of duodenum ± adjacent inflammation
TOP DIFFERENTIAL DIAGNOSES
• Cholecystitis
• Pancreatitis
• Ureteral colic
PATHOLOGY
• Gastritis commonly coexists with duodenitis
Similar findings of mucosal erosions, fold thickening, luminal spasm
CLINICAL ISSUES
• Most common signs/symptoms
Abdominal pain, nausea, vomiting
• Other signs/symptoms
Gastrointestinal bleeding with deeper ulceration
• Epidemiology
Helicobacter pylori infection and NSAID use
• Treated with proton-pump inhibitors (plus antibiotics for H. pylori)
DIAGNOSTIC CHECKLIST
• Duodenitis often coexists with gastritis
• Symptoms are indistinguishable from peptic ulcers
Presence of only superficial (aphthous) erosions and fold thickening distinguishes duodenitis from duodenal ulcer
• Diagnosis usually established by endoscopy
(Left) Spot film from an upper GI series shows aphthous ulcers in the gastric antrum and duodenal bulb, along with thickened duodenal folds , classic features of duodenitis and gastritis.
(Right) Spot film from an upper GI series shows nodular fold thickening and lack of distensibility in the gastric antrum due to gastritis.
(Left) Another spot film from the upper GI series shows spasm and fold thickening of the duodenum , due to duodenitis.
(Right) Axial CECT in the same patient shows luminal narrowing and mural thickening of the 2nd portion of duodenum, with surrounding inflammation due to duodenitis.
TERMINOLOGY
Definitions
• Duodenal inflammation from any cause
IMAGING
General Features
• Best diagnostic clue
Upper GI: Aphthous ulcers in duodenal bulb; fold thickening in antrum and duodenal bulb
CECT: Mural thickening of duodenum ± adjacent inflammation
• Location
Duodenum
• Size
Ulcers 3-7 mm
• Morphology
Discrete erosions with surrounding mound of edema in ring-like fashion
Imaging Recommendations
• Best imaging tool
Upper GI, CECT
• Protocol advice
Oral and IV contrast
Radiographic Findings
• Radiography
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in the gastric antrum and duodenal bulb, along with thickened duodenal folds 
, classic features of duodenitis and gastritis.
and lack of distensibility in the gastric antrum due to gastritis.
, due to duodenitis.
due to duodenitis.
