Ultrasound demonstration of giant duodenal ulcer

Abstract

Abstract. Two cases of giant duodenal ulcer demonstrated by ultrasonography are described. The giant ulcer craters appeared as cystic structures on sonographic examination. The differential diagnosis and the role of ultrasound in the diagnosis of giant duodenal ulcer are discussed.Key words: Ultrasound -Giant duodenal ulcer.Giant duodenal ulcer may occasionally be seen as a cystic structure on ultrasound examination. Two such cases are described. To our knowledge, this appearance has not been described previously in the literature. Case Reports Case 1A 31-year-old man was admitted to the hospital with complaints of upper abdominal pain for 2 weeks. The patient had a fever as high as 100.4 ~ . White blood cell count on admission was 15,600 and rose to 17,000/cu mm. Serum amylase on admission was 270 and dropped to 100, indicating resolution of mild pancreatitis. On the second day after admission, the patient vomited 50-75 cc of dark, bloody fluid.Ultrasound examination of the pancreas performed 2 days after admission revealed no evidence of enlargement or edema of the pancreas. The pancreatic duct was also normal in size. Therefore, there was no sonographic evidence of acute pancreatitis. Lateral to the head of the pancreas was a hypoechoic solid mass with a central echogenic area. This had the so-called pseudo-kidney appearance. Because this mass was contiguous with the walls of the gastric antrum, which were clearly delineated, it was thought to represent thickening of the duodenal wall. Within part of this mass, a 2.5 cm cystic area was seen surrounded by a hypoechoic solid rim, 1-1.5 cm in thickness (Fig. 1A). This cystic area did Address reprint requests to: Suhas G. Parulekar, M.B.B.S., Department of Radiology, Mt. Sinai Medical Center, 1800 East 105th Street, Cleveland, OH 44106, USA not appear to change in size or shape during repeated examinations with static and real time scanners. Therefore, the possibility that this might represent a large duodenal ulcer filled with secretions and the hypoechoic thickening around the cystic area might reprelent inflamed duodenal wall around the ulcer was considered. The stomach and duodenal region were not examined after oral ingestion of water because the patient was nauseous and had considerable abdominal pain.Upper GI series performed the following day confirmed the presence of a 3.5 cm giant ulcer replacing the duodenal bulb (Fig. 1 B). This diagnosis was confirmed by endoscopy, which revealed a large ulcer in the duodenum surrounded by considerable edema and inflammation. A repeat upper GI series 2 weeks after medical therapy showed that this ulcer crater was considerably reduced. Case 2A 67-year-old man was admitted with a 1-month history of postprandial epigastric pain relieved by eating.Upper GI series 1 day prior to admission to the hospital demonstrated a 3.5 cm giant ulcer in the duodenal bulb ( Fig. 2A).Ultrasound examination of the abdomen was performed 2 days after admission because of persistent abdominal pain. The pancreas appeared normal in echogenicit...

Diagnosis of Perforated Gastric Ulcers by Ultrasound

“…Another indirect sign is a thickness of the gall bladder wall of more than 5 mm [5,14,16]. An hypoechoic thick zone around the fluid-filled ulcers has also been described [17]. According to the present case, fluid between liver and stomach is found frequently.…”