When gastric disease is suspected, the CT examination should be performed with intravenous (IV) contrast (to assess for submucosal edema, mucosal hyperenhancement due to inflammation, a focal outpouching of the mucosal bowel lining resulting from the crater of the ulcer, focal interruption of mucosal enhancement resulting from the ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer, or muscularis propria) and a neutral oral contrast such as water or dilute barium suspension (positive oral contrast can impede assessment of mucosal enhancement and preclude assessment of intraluminal bleeding) [12]. There is limited value of performing a CT abdomen and pelvis without and with IV contrast for this indication. A CT examination without IV contrast may help in diagnosing PUD by detecting findings such as extraluminal gas, reactive fluid, fat stranding along the gastroduodenal region, ascites, focal wall defect, or a large ulcer. However, the addition of IV contrast significantly improves conspicuity of findings such as interrupted mucosal enhancement and bowel wall hyperenhancement, making the CT examination more sensitive in diagnosis. CT Abdomen Although a CT abdomen examination may provide the same clues to diagnose acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer as a CT abdomen and pelvis examination, the latter is usually chosen when overlapping or nonspecific symptoms are encountered. If gastric disease is strongly suspected, it would be appropriate to omit the pelvis from the examination. When gastric disease is suspected, the CT examination should be performed with IV contrast (to assess for submucosal edema, mucosal hyperenhancement due to inflammation, a focal outpouching of the mucosal bowel Epigastric Pain
Epigastric Pain. When gastric disease is suspected, the CT examination should be performed with intravenous (IV) contrast (to assess for submucosal edema, mucosal hyperenhancement due to inflammation, a focal outpouching of the mucosal bowel lining resulting from the crater of the ulcer, focal interruption of mucosal enhancement resulting from the ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer, or muscularis propria) and a neutral oral contrast such as water or dilute barium suspension (positive oral contrast can impede assessment of mucosal enhancement and preclude assessment of intraluminal bleeding) [12]. There is limited value of performing a CT abdomen and pelvis without and with IV contrast for this indication. A CT examination without IV contrast may help in diagnosing PUD by detecting findings such as extraluminal gas, reactive fluid, fat stranding along the gastroduodenal region, ascites, focal wall defect, or a large ulcer. However, the addition of IV contrast significantly improves conspicuity of findings such as interrupted mucosal enhancement and bowel wall hyperenhancement, making the CT examination more sensitive in diagnosis. CT Abdomen Although a CT abdomen examination may provide the same clues to diagnose acid reflux, esophagitis, gastritis, peptic ulcer, or duodenal ulcer as a CT abdomen and pelvis examination, the latter is usually chosen when overlapping or nonspecific symptoms are encountered. If gastric disease is strongly suspected, it would be appropriate to omit the pelvis from the examination. When gastric disease is suspected, the CT examination should be performed with IV contrast (to assess for submucosal edema, mucosal hyperenhancement due to inflammation, a focal outpouching of the mucosal bowel Epigastric Pain