Cross-Sectional Imaging of Small Bowel Malignancies

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Presentation transcript:

Cross-Sectional Imaging of Small Bowel Malignancies Dellano D. Fernandes, MD, Ram Prakash Galwa, MD, Najla Fasih, MD, FRCR, Margaret Fraser-Hill, MDCM, FRCPC Canadian Association of Radiologists Journal Volume 63, Issue 3, Pages 215-221 (August 2012) DOI: 10.1016/j.carj.2010.10.001 Copyright © 2012 Terms and Conditions

Figure 1 Adenocarcinoma. (A, B, C) A 56-year-old man who presented with persistent vomiting and weight loss. Endoscopy revealed a tight stenosis of the duodenum. (A) Contrast-enhanced computed tomography (CT) images show abnormal dilatation of the proximal duodenum (asterisk), abrupt transition to a stenotic mass in the third stage (m) (black arrows) with lobulated intraluminal margin, ill-defined outer margin, and multiple surrounding small solid lymph nodes (white arrows). (B) There are multiple small, peripherally-enhancing solid liver metastases. (C) T2-weighted coronal magnetic resonance image of a similar stenotic, “apple core” duodenal adenocarcinoma (white arrows) in another patient. (D) Crohn disease with obstructing jejunal adenocarcinoma. Contrast-enhanced CT showing small bowel obstruction from a solid, stenotic mass (arrow) with lobulated intraluminal margin, thick enhancing mucosal layer, abrupt transition, and shouldered margin. Canadian Association of Radiologists Journal 2012 63, 215-221DOI: (10.1016/j.carj.2010.10.001) Copyright © 2012 Terms and Conditions

Figure 2 Carcinoid tumour. (A, B) Axial and coronal computed tomography (CT) images show a small, lobulated mesenteric mass containing punctate calcifications and showing surrounding retractile desmoplastic fibrosis (white arrows). The primary bowel lesion was not seen. (C, D) This elderly, cachectic woman presented with multiple, increasingly frequent and prolonged episodes of bowel obstruction. CT scan (C) and abdominal plain film (D) show severely distended bowel from chronic obstruction. Contrast-enhanced CT (C) shows absence of subcutaneous and intra-abdominal fat, severe generalized small bowel dilatation, static intraluminal contents, and solid enhancing mass (white arrows) at the point of transition to normal calibre collapsed small bowel in the pelvis. Surgically confirmed carcinoid tumour. Canadian Association of Radiologists Journal 2012 63, 215-221DOI: (10.1016/j.carj.2010.10.001) Copyright © 2012 Terms and Conditions

Figure 3 Lymphoma. This middle-aged man presented with right lower quadrant discomfort. Ultrasound (A) and unenhanced computed tomography (B) reveal a solid, homogeneous right lower quadrant mass (A and B, white star). There was bulky, homogeneous adenopathy (C, white arrows) and abnormal thickening of multiple ileal loops without obstruction (D, black arrows). Canadian Association of Radiologists Journal 2012 63, 215-221DOI: (10.1016/j.carj.2010.10.001) Copyright © 2012 Terms and Conditions

Figure 4 Gastrointestinal stromal tumour (GIST). (A-D) This 44-year-old man presented with abdominal distention and pain. (A) Contrast-enhanced computed tomography (CT) shows a dumbbell-shaped, heterogeneously enhancing mass originating from small bowel (white arrows). Magnetic resonance imaging coronal T1-weighted (B), coronal T2-weighted (C), and axial contrast-enhanced (D) images show a heterogeneous solid mass with central necrosis, hemorrhage and heterogeneous enhancement (D, white arrow). (E) A 53-year-old man presented with acute abdominal pain, peritonitis and suspected appendicitis. Contrast-enhanced CT (E) shows a cavitated mid-abdominal soft-tissue mass containing gas and fluid, with surrounding inflammation and trace ascites. The wall of the lesion is irregular anteriorly where it was found to be perforated at surgery. Canadian Association of Radiologists Journal 2012 63, 215-221DOI: (10.1016/j.carj.2010.10.001) Copyright © 2012 Terms and Conditions

Figure 5 Metastatic disease. Melanoma metastases to the small bowel. (A) Arterial phase computed tomography (CT) scan shows multiple small, hypervascular enhancing submucosal nodular lesions (white arrows). (B) Venous phase CT scan in the same patient shows a larger metastatic deposit acting as a lead point for jejunojejunal intussusception (white arrow). There are also solid superficial fascial metastatic deposits in the left anterior abdominal wall and right gluteal region (white arrowheads). Canadian Association of Radiologists Journal 2012 63, 215-221DOI: (10.1016/j.carj.2010.10.001) Copyright © 2012 Terms and Conditions