Emphysematous gastritis
During imaging of emphysematous gastritis and gastric emphysema, the key diagnostic marker is the presence of gas within the thickness of the organ.
- Radiographic appearance: thin, curvilinear strips of radiolucent gas are visualized. They are always located strictly parallel to the gastric wall.
- Computed tomography (CT): is the method of choice, as it has extremely high sensitivity in detecting even minimal accumulations of gas within the gastric wall.
Prepyloric membrane
The prepyloric membrane, also known as the antral mucosal diaphragm (Prepyloric Web, Antral Mucosal Diaphragm), is a congenital developmental anomaly.
Morphologically, it is a hypertrophied mucosal fold that has a diaphragm-like shape and is oriented perpendicularly to the longitudinal axis of the organ. This thin membrane divides the distal antrum. As a result, a small third chamber is formed between the proximal antrum and the duodenal bulb.
- Radiographic signs: the membrane appears as a thin, constant, and circular smooth band located 3–4 cm from the pylorus. The newly formed antral chamber can visually mimic a second duodenal bulb.
- Clinical presentation: most often asymptomatic, but in some cases, the membrane can provoke symptoms of gastric outlet obstruction.
Gastric diverticula
Gastric diverticula are divided into true and intramural (partial) diverticula, with each form having its own localization and structural features.
True diverticula:
- Localization: predominantly the posterior wall of the gastric fundus (fundus), inferior to the gastroesophageal junction near the lesser curvature. They are extremely rare in the antrum.
- Morphology: contain a full muscular layer (muscularis propria), allowing them to exhibit independent peristalsis. Dimensions can reach several centimeters.
- Visualization: easily fill with barium. On an upright radiograph, a characteristic barium-air level may be determined. On unenhanced CT, the picture is often nonspecific.
- Differential diagnosis: if the diverticulum does not fill with barium, it can be mistaken for an ulcer or a submucosal mass.
Intramural (partial) diverticula: A rare anomaly representing an invagination of the mucosa into the wall.
- Morphology: up to 1 cm in size; in profile, they have a lenticular shape with a small opening communicating with the lumen.
- Localization: greater curvature of the distal antrum.
- Diagnostic pitfalls: can mimic ulcers or ectopic pancreatic tissue.
Hypertrophic pyloric stenosis
Congenital form (Hypertrophic Pyloric Stenosis): A relatively frequent condition detected in infancy (ultrasound is the method of choice). It is rare in adults. The underlying pathology is hypertrophy and hyperplasia of the circular muscles of the pyloric channel, leading to its elongation and narrowing. On radiographs, the channel is elongated (up to 2–4 cm) with smooth symmetric narrowing. A specific symptom is the retrograde protrusion of the hypertrophied muscle into the antrum (the "shoulder" sign or shoulder).
Acquired form: Usually develops as a consequence of peptic ulcer disease or another inflammatory process. The main radiographic distinction from the congenital form is that acquired stenosis typically lacks retrograde muscle protrusion.
Varices and gastric distention
Gastric veins act as collateral pathways in portal hypertension. Most commonly, they are affected alongside esophageal veins.
Isolated gastric varices (without esophageal involvement) are a specific sign of splenic vein thrombosis, which frequently occurs secondary to pancreatitis or pancreatic cancer. Such veins are predominantly localized in the gastric fundus around the gastroesophageal junction.
- Radiographic appearance: dilated, effaceable polypoid folds. They may appear nodular, grape-like (grape-like), or mimic gastric cancer (a mass lesion). Double-contrast studies reveal serpiginous (serpiginous) submucosal nodes.
- Diagnostics: transabdominal ultrasound, endoscopic ultrasound (EUS), contrast-enhanced MDCT (MDCT), and MRI. On tomograms, lesions are clearly visualized as contrast-enhancing submucosal vessels in the venous phase.
Gastric distention (Gastric Distention): Can be obstructive or non-obstructive in nature. More than 90% of gastric outlet obstruction cases are caused by peptic ulcer disease (PUD) and gastric cancer.
Class and exam questions
How to radiographically differentiate congenital hypertrophic pyloric stenosis from the acquired form?
In congenital pyloric stenosis, the hypertrophied muscle retrogradely protrudes into the antrum, creating the "shoulder" sign. In acquired stenosis (e.g., secondary to peptic ulcer disease), such retrograde protrusion is generally absent.
What does isolated gastric variceal dilation indicate?
The presence of gastric varices in the absence of esophageal varices is a classic sign of splenic vein thrombosis (often associated with pancreatic pathology).
What must a true diverticulum of the stomach be differentiated from if it fails to fill with barium?
A barium-empty true diverticulum can radiographically mimic a submucosal mass or be misdiagnosed as a gastric ulcer.
What else to study on this topic
- Radiographic patterns of gas accumulation in the walls of hollow organs
- Endoscopic ultrasound (EUS) in the differential diagnosis of submucosal lesions
- Ultrasound criteria for congenital hypertrophic pyloric stenosis in infants
- MDCT protocols for visualizing collateral blood flow in portal hypertension
Master the entire topic in the "Diagnostic Radiology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Emphysematous gastritis" and 2,199 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 10 video lessons on the subject
Other topics in the section "Diagnostic Radiology of the Abdominal Organs"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.