Near gastroesophageal (GE) junction, on posterior aspect of lesser curvature of stomach
• Usually 1-3 cm, up to 10 cm in diameter
• On upper GI series
Barium-filled diverticulum with air-fluid level
• CT findings
Often in suprarenal location
– Mimics adrenal or pancreatic mass
Connection to stomach may be subtle
Air-filled, fluid-filled, or contrast-filled mass
No enhancement of contents
TOP DIFFERENTIAL DIAGNOSES
• Adrenal mass
• Pancreatic tumor
• Abdominal abscess
• Ectopic pancreatic tissue
PATHOLOGY
• Pouch/sac includes 3 normal layers of bowel wall: Mucosa, submucosa, and muscularis propria
CLINICAL ISSUES
• Complications (rare)
Bleeding
Ulceration
Carcinoma
• No treatment needed unless complications occur
DIAGNOSTIC CHECKLIST
• Incidental finding that may be mistaken for adrenal mass on CT or MR
Barium studies or CT in supine and prone position with oral contrast and gas granules will differentiate diverticulum from mass
(Left) Upright film from an upper GI series shows a typical gastric diverticulum with an air-contrast level seen within an outpouching near the gastric cardia.
(Right) Axial CECT in the same patient shows a near water density mass projecting posterior to the gastric fundus . The connection to the stomach is much more difficult to see on CT. Distention of the stomach with oral contrast or gas granules may be required to make the diagnosis on a CT scan.
(Left) CECT shows an oval mass containing water density fluid and gas. On more cephalic sections, the “mass” was contiguous with the posterior wall of the fundus.
(Right) On a slightly more inferior image, note how the diverticulum extends dorsal to the pancreas and splenic vein. Without the presence of the air-fluid level it would be difficult to distinguish this from an adrenal mass. An upper GI series confirmed a typical juxtacardiac diverticulum.
TERMINOLOGY
Definitions
• Pouch or sac opening from stomach
IMAGING
General Features
• Best diagnostic clue
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with an air-contrast level seen within an outpouching near the gastric cardia.
projecting posterior to the gastric fundus 
. The connection to the stomach is much more difficult to see on CT. Distention of the stomach with oral contrast or gas granules may be required to make the diagnosis on a CT scan.
containing water density fluid and gas. On more cephalic sections, the “mass” was contiguous with the posterior wall of the fundus.
extends dorsal to the pancreas and splenic vein. Without the presence of the air-fluid level it would be difficult to distinguish this from an adrenal mass. An upper GI series confirmed a typical juxtacardiac diverticulum.
