Duodenitis

Published on 20/07/2015 by admin

Filed under Radiology

Last modified 20/07/2015

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 Upper GI, CECT

• Best diagnostic clue

image Upper GI: Aphthous ulcers, fold thickening, luminal spasm of duodenal bulb (± gastric antrum)
image CECT: Mural thickening of duodenum ± adjacent inflammation

TOP DIFFERENTIAL DIAGNOSES

• Cholecystitis
• Pancreatitis
• Ureteral colic

PATHOLOGY

• Gastritis commonly coexists with duodenitis

image Similar findings of mucosal erosions, fold thickening, luminal spasm

CLINICAL ISSUES

• Most common signs/symptoms

image Abdominal pain, nausea, vomiting
• Other signs/symptoms

image Gastrointestinal bleeding with deeper ulceration
• Epidemiology

image 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

image Presence of only superficial (aphthous) erosions and fold thickening distinguishes duodenitis from duodenal ulcer
• Diagnosis usually established by endoscopy
image
(Left) Spot film from an upper GI series shows aphthous ulcers image in the gastric antrum and duodenal bulb, along with thickened duodenal folds image, classic features of duodenitis and gastritis.

image
(Right) Spot film from an upper GI series shows nodular fold thickening image and lack of distensibility in the gastric antrum due to gastritis.
image
(Left) Another spot film from the upper GI series shows spasm and fold thickening of the duodenum image, due to duodenitis.

image
(Right) Axial CECT in the same patient shows luminal narrowing and mural thickening of the 2nd portion of duodenum, with surrounding inflammation image due to duodenitis.

TERMINOLOGY

Definitions

• Duodenal inflammation from any cause

IMAGING

General Features

• Best diagnostic clue

image Upper GI: Aphthous ulcers in duodenal bulb; fold thickening in antrum and duodenal bulb
image CECT: Mural thickening of duodenum ± adjacent inflammation
• Location

image Duodenum
• Size

image Ulcers 3-7 mm
• Morphology

image Discrete erosions with surrounding mound of edema in ring-like fashion

Imaging Recommendations

• Best imaging tool

image Upper GI, CECT
• Protocol advice

image Oral and IV contrast

Radiographic Findings

• Radiography

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