Imaging Approach to the Duodenum

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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(Left) The duodenum is retroperitoneal, except for the bulb (1st portion)

. The 3rd portion of duodenum crosses in front of the aorta and behind the superior mesenteric vessels

.

(Right) The 2nd portion of duodenum is attached to the pancreatic head and lies in close proximity to the right renal hilum. The ampulla of Vater lies along the medial wall of the 2nd duodenum. The hepatoduodenal ligament attaches the duodenum to the porta hepatic and contains the bile duct, portal vein, and hepatic artery.

(Right) The 2nd portion of duodenum is attached to the pancreatic head and lies in close proximity to the right renal hilum. The ampulla of Vater lies along the medial wall of the 2nd duodenum. The hepatoduodenal ligament attaches the duodenum to the porta hepatic and contains the bile duct, portal vein, and hepatic artery.

(Left) Spot film from an upper GI series shows a typical diverticulum extending from the medial border of the 2nd portion of the duodenum.

(Left) Spot film from an upper GI series shows a typical diverticulum extending from the medial border of the 2nd portion of the duodenum.

(Right) Axial CT in the same patient shows an air-fluid level within the duodenal diverticulum . A completely fluid-filled diverticulum may mimic a cystic mass in the head of the pancreas.

(Right) Axial CT in the same patient shows an air-fluid level within the duodenal diverticulum . A completely fluid-filled diverticulum may mimic a cystic mass in the head of the pancreas.

(Left) Film from an upper GI series in a patient with SMA syndrome shows the straight line demarcation of the midline duodenum, with dilation of the upstream duodenal lumen . The remainder of the small bowel is normal.

(Left) Film from an upper GI series in a patient with SMA syndrome shows the straight line demarcation of the midline duodenum, with dilation of the upstream duodenal lumen . The remainder of the small bowel is normal.

(Right) Film from an upper GI series in a patient with scleroderma shows a “megaduodenum” . Dilation of the small bowel lumen and a “hidebound” appearance of the small bowel folds (thin and closely spaced) are typical features of this disease.

(Right) Film from an upper GI series in a patient with scleroderma shows a “megaduodenum” . Dilation of the small bowel lumen and a “hidebound” appearance of the small bowel folds (thin and closely spaced) are typical features of this disease.

(Left) Film from an upper GI series shows multiple small polypoid masses in the duodenal bulb and descending duodenum. Endoscopic biopsy revealed hyperplasia and elements of hamartoma arising from Brunner glands.

(Left) Film from an upper GI series shows multiple small polypoid masses in the duodenal bulb and descending duodenum. Endoscopic biopsy revealed hyperplasia and elements of hamartoma arising from Brunner glands.

(Right) Upper GI series in a young patient with duodenal carcinoma and Gardner syndrome shows a large mass filling much of the 2nd and 3rd portions of the duodenum. Note the “apple core” appearance, similar to that of colon cancer.

(Right) Upper GI series in a young patient with duodenal carcinoma and Gardner syndrome shows a large mass filling much of the 2nd and 3rd portions of the duodenum. Note the “apple core” appearance, similar to that of colon cancer.

(Left) Spot film from an upper GI series shows a mass causing abrupt narrowing of the duodenal lumen and irregularity or destruction of the duodenal mucosa.

(Left) Spot film from an upper GI series shows a mass causing abrupt narrowing of the duodenal lumen and irregularity or destruction of the duodenal mucosa.

(Right) Coronal CECT in the same patient shows a soft tissue density mass within the duodenal lumen. The mass was resected and proved to be a large adenomatous polyp with foci of frank carcinoma.

(Right) Coronal CECT in the same patient shows a soft tissue density mass within the duodenal lumen. The mass was resected and proved to be a large adenomatous polyp with foci of frank carcinoma.

(Left) CT shows a thick-walled stomach with extraluminal oral contrast medium and gas tracking from the duodenal bulb. Surgery confirmed a perforated ulcer of the duodenal bulb and gastritis.

(Left) CT shows a thick-walled stomach with extraluminal oral contrast medium and gas tracking from the duodenal bulb. Surgery confirmed a perforated ulcer of the duodenal bulb and gastritis.

(Right) Axial CECT shows gas in the perirenal space, surrounding the kidney . While this might suggest a primary renal process, the correct diagnosis of a perforated duodenal ulcer is made by the finding of extraluminal gas surrounding the 2nd and 3rd portions of duodenum with its thickened wall.

(Right) Axial CECT shows gas in the perirenal space, surrounding the kidney . While this might suggest a primary renal process, the correct diagnosis of a perforated duodenal ulcer is made by the finding of extraluminal gas surrounding the 2nd and 3rd portions of duodenum with its thickened wall.

(Left) Axial CECT in an elderly man with nausea and early satiety shows that the stomach, duodenal bulb , and pancreatic head appear normal.

(Left) Axial CECT in an elderly man with nausea and early satiety shows that the stomach, duodenal bulb , and pancreatic head appear normal.

(Right) Axial CECT in the same patient shows a large, heterogeneously hypervascular mass arising from the duodenum.

(Right) Axial CECT in the same patient shows a large, heterogeneously hypervascular mass arising from the duodenum.

(Left) Coronal MIP reconstruction in the same patient shows the exophytic, hypervascular mass arising from the duodenum.

(Left) Coronal MIP reconstruction in the same patient shows the exophytic, hypervascular mass arising from the duodenum.

(Right) Another MIP reconstruction in the same patient shows foci of necrosis and calcification within the mass . All features are characteristic of a duodenal GIST, confirmed at surgery. The duodenum is one of the more common locations for GI stromal tumors.

(Right) Another MIP reconstruction in the same patient shows foci of necrosis and calcification within the mass . All features are characteristic of a duodenal GIST, confirmed at surgery. The duodenum is one of the more common locations for GI stromal tumors.

Diagnostic Imaging_ Gastrointes - Michael P Federle