Gastrohepatic ligament lymphnode enlargement
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This 39 year-old male patient presented with epigastric pain. The contrast-enhanced CT above shows multiple rounded structures in the region of the gastrohepatic ligament (click image for arrows). 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). The differential diagnosis included: gastritis or gastric ulcer with reactive lymphadenopathy; gastric lymphoma; gastrointestinal stromal tumour; and gastric carcinoma.
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 lymphadenopathy.
Ninety-five percent of gastric ulcers are benign. Twenty to thirty percent are multiple. Major risk factors include H. pylori infection and non-steroidal anti-inflammatory drugs. Minor risks include steroids, smoking, alcohol, coffee, and stress. Less common causes include Zollinger-Ellison syndrome,hyperparathyroidism, head injury (Cushing ulcer), or burns (Curling ulcer).