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Gastrohepatic ligament lymph node enlargement

Case contributed by Dr Laughlin Dawes

Presentation:

Epigastric pain.

Patient Data:

Age: 39 years
Gender: Male
Modality: CT

Multiple rounded structures in the region of the gastrohepatic ligament. The structures do not enhance to the same degree as the portal vein, making gastric varices unlikely. The structures most probably represent enlarged lymph nodes. The scan also demonstrated moderate thickening of the gastric wall (not shown). 

Case Discussion:

An endoscopy was performed and a gastric ulcer found. Biopsies of the ulcer showed no evidence of malignancy. The final diagnosis is gastric ulcer with reactive lymph node enlargement.

95% of gastric ulcers are benign. 20-30% are multiple. Major risk factors include:

  • H. pylori infection
  • non-steroidal anti-inflammatory drugs (NSAIDs) 

Minor risks factors include:

  • steroids
  • smoking
  • alcohol
  • coffee
  • stress

Less common causes include Zollinger-Ellison syndrome, hyperparathyroidism, head injury (Cushing ulcer), or burns (Curling ulcer).

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