Man with lower extremity pain.

Contributed from the case records of the  Indiana University Department of Radiology

Man with lower extremity pain.

Man with lower extremity pain.

Findings:

Axial 1 - Axial CT image with contrast of the abdomen showing a thin wall air fluid collection within the left upper quadrant consistent with gastric diverticulum.  Communication with the stomach is best seen on the coronal and sagittal images.  No significant fat stranding is seen surrounding the fluid collection.

Coronal - Coronal CT image with contrast of the abdomen revealing a thin walled air fluid collection within the left upper quadrant with gastric communication consistent with a gastric diverticulum.

Sagittal 1 - Gastric - Sagittal CT image with contrast of the abdomen revealing a thin walled air fluid collection within the left upper quadrant with gastric communication consistent with a gastric diverticulum.

Sagittal 2 - Spleen - Sagittal CT image with contrast of the abdomen revealing a thin walled air fluid collection within the left upper quadrant anterior to the spleen and without communication with the kidney.

• Gastric diverticulum
• Pancreatic pseudocyst
• Abdominal abscess
• Renal cyst

Man with lower extremity pain.

Gastric diverticulum are often found as benign incidental findings on abdominal imaging. The diverticulum can be a true diverticulum involving all three layers of stomach or can be false involving only some of the layers. Most are asymptomatic and require no intervention. Rarely the patient can be symptomatic with bleeding, ulceration or carcinoma requiring surgical removal.

• Key finding is identifying air fluid filled mass with communication with the stomach.
• Differential diagnosis: Adrenal mass, ectopic pancreatic tissue, abdominal abscess, pancreatic pseudocyst, renal cyst.
• Gastric diverticulum do not enhance this finding may help differentiate from adrenal masses that usually enhance. Clinical history and surrounding inflammation may help differentiate from abdominal abscesses.
• Barium studies or supine and prone CT studies with oral contrast and gas granules can help identify gastric communication.

• Found in 0.02% (2 in 10,000) of autopsies.
• Most are asymptomatic, without gender or age preference.
• More than 75% are juxtacardiac, often on the posterior aspect of the lesser curvature.
• Usually measure 1-3 cm in diameter but have been seen as large as 10 cm.
• May often be found in suprarenal position similar to adrenal mass.
• Key finding is identifying air fluid filled mass with communication with the stomach.

1. https://my.statdx.com/STATdxMain.jsp?rc=false#dxContent;gastric_diverticulum. 09/30/2011

Man with lower extremity pain.