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Case 54 - Gastric antral wall thickening

from Section 9 - Gastrointestinal tract

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

The normal gastric antrum commonly measures over 5 mm and may measure as much as 12 mm in thickness at CT (Figures 54.1 and 54.2) [1].

Importance

Misinterpretation of antral wall thickening as inflammation or tumor may lead to unnecessary treatment or investigation.

Typical clinical scenario

Smooth thickening of the gastric antrum was seen in 152 of 153 (99%) consecutive patients without gastric disease undergoing CT [1]. The antral wall thickness exceeded 10 mm in seven patients (5%). Linear submucosal low attenuation (mural stratification) of the thickened portion of the gastric antrum was noted in 36 patients (24%), and in 14 of these cases the low density appeared to be of fat attenuation.

Differential diagnosis

Wall thickening of the gastric antrum is often misinterpreted as “antral gastritis”. However, in a controlled study there was no association between antral wall thickness and Helicobacter pylori infection [2], and a prior study that suggested such an association lacked a control group, so the result may have been spurious [3].

Teaching point

Wall thickening of the gastric antrum is usually a normal finding and should not be misinterpreted as indicating inflammation or tumor.

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
, pp. 184 - 185
Publisher: Cambridge University Press
Print publication year: 2010

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References

Pickhardt, PJ, Asher, DB. Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison. Am J Roentgenol 2003; 181: 973–979.CrossRefGoogle ScholarPubMed
Kul, S, Sert, B, Sari, A, et al. Effect of subclinical helicobacter pylori infection on gastric wall thickness: multislice CT evaluation. Diagn Interv Radiol 2008; 14: 138–142.Google ScholarPubMed
Urban, BA, Fishman, EK, Hruban, RH. Helicobacter pylori gastritis mimicking gastric carcinoma at CT evaluation. Radiology 1991; 179: 689–691.CrossRefGoogle ScholarPubMed

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