Winner of CoW 14 August 2016
Growth second part of duodenum with IHBR ,CBD dilatation and retroperitoneal lymphadenopathy.
Findings
An ill defined hypodense mass lesion showing heterogenous contrast enhancement noted arising from second part of duodenum with circumferential wall thickening compressing head of pancreas causing bilateral IHBR and CBD dilatation. Multiple enlarged peripancreatic and para aortic lymphnodes.
Discussion
The duodenum is often overlooked on computed tomographic (CT) scans, and its length belies its importance in the gastrointestinal tract. Its location, with both intraperitoneal and retroperitoneal segments and proximity to the gallbladder, pancreas, stomach, spine, aorta, liver, and other segments of the gastrointestinal tract, results in duodenal involvement by a multitude of primary and secondary processes. Malignant primary neoplasms of the duodenum are rare. Adenocarcinoma is the most common primary malignant neoplasm of the duodenum, with 50%–70% of small bowel adenocarcinomas occurring either in the duodenum or proximal jejunum. The peak prevalence is in the 7th decade, and patients present with signs of bleeding, jaundice, or obstruction. Patients with this neoplasm tend to present at an advanced stage, with more than 50% of them having metastases at the time of diagnosis . At CT, one sees a polypoid or intramural mass . Rare tumors such as paragangliomas can also occur in the duodenum. These neoplasms can occur in external, intramural, or intraluminal locations, typically in the second or third portions of the duodenum. At CT and magnetic resonance (MR) imaging, these tumors are soft-tissue-attenuation masses with homogeneous enhancement and have a characteristic smoothly margined “dumbbell” appearance
Reference
Radiographics- CT of the Duodenum: An Overlooked Segment Gets Its Due
Findings
An ill defined hypodense mass lesion showing heterogenous contrast enhancement noted arising from second part of duodenum with circumferential wall thickening compressing head of pancreas causing bilateral IHBR and CBD dilatation. Multiple enlarged peripancreatic and para aortic lymphnodes.
Discussion
The duodenum is often overlooked on computed tomographic (CT) scans, and its length belies its importance in the gastrointestinal tract. Its location, with both intraperitoneal and retroperitoneal segments and proximity to the gallbladder, pancreas, stomach, spine, aorta, liver, and other segments of the gastrointestinal tract, results in duodenal involvement by a multitude of primary and secondary processes. Malignant primary neoplasms of the duodenum are rare. Adenocarcinoma is the most common primary malignant neoplasm of the duodenum, with 50%–70% of small bowel adenocarcinomas occurring either in the duodenum or proximal jejunum. The peak prevalence is in the 7th decade, and patients present with signs of bleeding, jaundice, or obstruction. Patients with this neoplasm tend to present at an advanced stage, with more than 50% of them having metastases at the time of diagnosis . At CT, one sees a polypoid or intramural mass . Rare tumors such as paragangliomas can also occur in the duodenum. These neoplasms can occur in external, intramural, or intraluminal locations, typically in the second or third portions of the duodenum. At CT and magnetic resonance (MR) imaging, these tumors are soft-tissue-attenuation masses with homogeneous enhancement and have a characteristic smoothly margined “dumbbell” appearance
Reference
Radiographics- CT of the Duodenum: An Overlooked Segment Gets Its Due
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!