Presentation
Gastroscopy 4 days ago for investigation of celiac disease. Since procedure nausea and vomiting with epigastric pain.
Patient Data
There is a 5.8 x 4 x 5.1 cm subhepatic mass centered upon the duodenum which appears to be intramural and of intermediate density (40 HU). This appears to mildly displace the adjacent head of pancreas and superior mesenteric vein and mildly compress the underlying inferior vena cava. Small locules of intramural gas is seen in duodenal wall medial to the mass. No adjacent fat stranding.The remainder of the bowels are unremarkable. The liver, pancreas, spleen, gallbladder, kidneys and adrenals are normal. No evidence of pneumoperitoneum. Small amount of pelvic fluid is physiological. The imaged lung bases are clear. No suspicious osseous lesions.
Conclusion: Intramural duodenal mass likely reflects a hematoma in this context. Correlation with the gastroscopy findings is suggested.
Indication:
Duodenal wall mass post gastroscopy and biopsy. ? Hematoma, ? Duodenal wall tumor
Findings:
Precontrast:
Predominantly anechoic ovoid region intimately related to second part of duodenum measuring 8 x 4 x 4 cm cyst. It contains some areas of internal echoes some of which are septated.
Postcontrast:
3 acquisitions with IV Definity.
There is a planar contrast enhancement within the duodenal wall lesion, consistent with this representing evolving hematoma.
Conclusion:
Duodenal wall hematoma.
Followup in 6-8 weeks could be performed for further reassurance.
Case Discussion
Although the CT was suggestive of duodenal hematoma, the contrast-enhanced ultrasound demonstrates the key differentiating feature between nonviable material such as hematoma, and viable tissue such as tumor.