Case Report. CT and Ultrasound of Gastric and Duodenal Duplications

Abstract

We present the radiological findings of gastric and duodenal duplications in four adults, in whom abdominal ultrasound, endoscopic ultrasound (EUS), and CT were primarily used for diagnosis. The diagnosis was surgically confirmed in all cases. Preoperative diagnosis of duplications was possible with ultrasound in three patients, in whom CT showed a nonspecific cystic structure. Ultrasound demonstrated a pathognomonic multilayered wall appearance suggestive of a digestive origin, including an echogenic inner mucosal layer and a hypoechoic muscular layer, better appreciated using EUS in one patient. In one case, digestive origin was confirmed by direct visualization of a peristaltic activity within the cystic wall after water ingestion. In the last patient, a non-specific heterogeneous mainly solid mass of the esophagogastric junction was found to be an adenocarcinoma arising from a duplication on the histological analysis of the surgical specimen.

Gastric Duplication Cyst

“…In most of the cases they are discovered incidentally. Ultrasonography, endoscopic ultrasonography, CT scans, and MRI may help the diagnosis to be established preoperatively [9, 10, 11]. …”

“…A communication between the cyst and gastric lumen can be visualized in some patients. Detection of associated vertebral and other congenital abnormalities in some patients may help the diagnosis, but the diagnosis is usually established at laparotomy [10, 12]. Treatment is surgical.…”

Diagnostic Challenge to Distinguish Gastric Duplication Cyst from Pancreatic Cystic Lesions in Adult

“…Contrast-enhanced CT typically demonstrates GDC as a thick-walled cystic lesion with enhancement of the inner lining (8,9). Calcification is occasionally observed on CT (6,10 (6,11).…”

Sonography of the right upper quadrant

“…Pancreatic varices produce multiple small fluid collections on gray-scale examination; with color Doppler, these prove to be venous collaterals. Duplication cysts of the duodenum can mimic pseudocysts as well and are also avascular (29). In patients with chronic pancreatitis, the gland may shrink, the duct may enlarge, and calcifications may appear in the ducts and in the parenchyma.…”