Gastric Diverticulum

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 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

image Barium-filled diverticulum with air-fluid level
• CT findings

image Often in suprarenal location

– Mimics adrenal or pancreatic mass
image Connection to stomach may be subtle
image Air-filled, fluid-filled, or contrast-filled mass
image 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)

image Bleeding
image Ulceration
image Carcinoma
• No treatment needed unless complications occur

DIAGNOSTIC CHECKLIST

• Incidental finding that may be mistaken for adrenal mass on CT or MR

image Barium studies or CT in supine and prone position with oral contrast and gas granules will differentiate diverticulum from mass
image
(Left) Upright film from an upper GI series shows a typical gastric diverticulum image with an air-contrast level seen within an outpouching near the gastric cardia.

image
(Right) Axial CECT in the same patient shows a near water density mass image projecting posterior to the gastric fundus image. 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.
image
(Left) CECT shows an oval mass image containing water density fluid and gas. On more cephalic sections, the “mass” was contiguous with the posterior wall of the fundus.

image
(Right) On a slightly more inferior image, note how the diverticulum image 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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