Imaging Approach to the Stomach

Published on 20/07/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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Inferior phrenic arteries
Right gastric artery
Right gastroepiploic artery
Esophageal branch of left gastric artery
Left gastric artery
Splenic artery
Left gastroepiploic artery
Branches of left and right gastric arteries
(Top) In “conventional” arterial anatomy of the stomach and duodenum (present in only 50% of the population), the left gastric artery arises from the celiac trunk, supplies the lesser curvature, and anastomoses with the right gastric artery, a branch of the proper hepatic artery. The greater curvature of the stomach is supplied by anastomosing branches of the gastroepiploic arteries, with the left arising from the splenic artery.
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Hepatogastric ligament
Hepatoduodenal ligament
Pyloric sphincter
Outer (longitudinal) muscle layer
Middle (circular) muscle layer
(Bottom) The lesser omentum extends from the stomach to the porta hepatis and can be divided into the broader, thinner hepatogastric ligament and the thicker hepatoduodenal ligament. Note the layers of gastric muscle, with the middle circular layer being the thickest.

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(Left) Axial CECT shows a near water density LUQ mass image that might be mistaken for an adrenal adenoma or other lesion. Its contiguity with the stomach and a tiny bubble of gas image suggest the correct etiology of gastric diverticulum.
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(Right) An upright film from an upper GI series in the same patient shows the juxtacardiac diverticulum image with an air-fluid level.
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(Left) In this patient who had chest pain following recent Nissen fundoplication and reduction of a large paraesophageal hernia, CT shows collections of gas and fluid image within the mediastinum, suggestive, but not diagnostic of a leak or perforation.

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(Right) CT in the same case shows intra-abdominal extension of gas image. Bilateral pleural effusions are also noted.
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(Left) Another CT section in the same case shows the intact fundoplication image, compressing the distal esophagus and proximal stomach.

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(Right) A spot film from an esophagram in the same case shows compression of the distal esophagus image from an intact fundoplication. Leak of contrast material image into the mediastinum and upper abdomen, however, confirms perforation (leak) of the esophagus or the gastric wrap itself.

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(Left) Film from an upper GI series 1 day following gastric banding procedure shows the gastric band image around the proximal stomach with the correct orientation. A leak of water-soluble contrast medium and gas is evident image.
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(Right) Upright spot film in a patient who had recent Roux-en-Y gastric bypass surgery shows a spherical distention of the gastric pouch image, with an air-fluid level and delayed emptying, signs of a stricture of the anastomosis between the gastric pouch and the Roux limb.
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(Left) Axial CECT in a young man with severe abdominal pain due to NSAID gastritis shows massive thickening and edema of the gastric wall image. Note the enhancing mucosa as distinct from near water density submucosal edema image.

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(Right) Axial CECT in a patient with gastric carcinoma shows a distended stomach (outlet obstruction) with a contracted antrum, thickened wall image, and submucosal soft tissue density. Adjacent lymphadenopathy image indicates spread beyond the stomach.
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(Left) In this patient with a palpable left upper quadrant mass, CT shows features of a gastric GIST. The stomach is indented along its dorsal surface by the mass image, which is necrotic in its center and contains a gas-fluid level image due to communication with the gastric lumen.

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(Right) A film from an upper GI series shows that the stomach is extremely reduced in size and was rigid and nonperistaltic. This linitis plastica appearance was the result of caustic ingestion (drain cleaner), but can also result from primary or metastatic carcinoma.