1. SYB case 2

2. 48 year old female presented to the ER with abdominal pain CT without contrast done to evaluate

4. Findings Intra-and extrahepatic biliary ductal dilation more prominent than expected post cholecystectomy

6. More Findings In the region of the pancreatic head/duodenum there is a heterogenous mass like area measuring 3.1x 2.2 cm Differential includes duodenal or pancreatic head mass or inflammation, but no inflammatory stranding is seen

9. Additional Findings Two 6mm soft tissue nodules within the omentum, one anterior to the liver other one lateral to the greater curvature of stomach.

10. These soft tissue densities together with the duodenal mass may represent a gastrointestinal stromal tumor with early omental implants. Recommend GI consult and ERCP for further evaluation

11. Discussion GIST are tumors of connective tissue They are the most common form of sarcoma, but still are rare One out of every 3-4 is malignant Found in stomach, small bowel, esophagus Present as abdominal pain, GI bleeding, trouble swallowing Most common site of spread is to liver, but can spread to peritoneum