1. SUBJECTIVE: 63 y/o, female Epigastric pain Vomiting Weight loss Early satiety Easy fatigability OBJECTIVE: CT scan: gastric mucosal thickening (+)pallor Pale palpebral conjunctiva (+) bulging flanks (+) epigastric tenderness (+) shifting dullness (+) fluid wave (-) succusion splash (+) soft 1x1 cm mass, above the pectinate line, 12 o’ clock position, non-tender SALIENT FEATURES

2. Benign Abdominal pain Weight loss and satiety Previous biopsy and endoscopy findings Abdominal pain Weight loss and satiety Worsening of symptoms despite CaCO3 Ascites and abdominal mass CT scan Benign or Malignant? Malignant

3. CT SCAN: 11/21/09

6. CT with contrast of the abdomen

7. Normal CT with contrast of the abdomen Patient’s CT with contrast (Nov 2009)

8. Discussion

9. CT with contrast of the abdomen

10. Normal CT with contrast of the abdomen Patient’s CT with contrast (Nov 2009)

13. Metastatic breast cancer to the stomach with a linitis plastica appearance on CT. MDCT image in an elderly woman with metastatic breast carcinoma and early satiety shows marked thickening of the wall of the gastric antrum (arrows). The radiographic findings are indistinguishable from those of a primary scirrhous carcinoma of the stomach.

14. Axial contrast- enhanced CT scan shows diffuse thickening of the stomach in this patient with gastric lymphoma.

15. Mucinous adenocarcinoma of the stomach. CT image shows massive thickening of the gastric wall and marked luminal narrowing by an advanced, infiltrating carcinoma. Also note extensive calcification within the tumor. This type of calcification is characteristic of mucinous adenocarcinomas of the stomach.

16. CT demonstrates subtle nodularity and stranding of the mesentery and more apparent nodularity along the greater omentum (arrows) in a patient with ovarian cancer. A small amount of ascites (A) also can be seen.