Findings suggestive of the diagnosis of gastritis or PUD on CT can include the following: gastric or duodenal wall thickening due to submucosal edema; mucosal hyperenhancement or fat stranding due to inflammation; fluid along the gastroduodenal region; focal outpouching of the mucosa resulting from ulcerations; focal interruption of mucosal enhancement resulting from an ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer or muscularis propria; focal perforation of a gastric ulcer with associated free air; or gastric outlet obstruction due to edema or chronic inflammatory changes near the antrum and pylorus [7,8]. Active bleeding from a peptic ulcer can be detected when hyperdense blood products accumulate at the site of the ulcer or in the stomach/duodenal lumen or as an area of active contrast extravasation [8]. PUD is the main cause of nontraumatic gastroduodenal perforation [11]. In a study by Lee et al [11], the following features were seen with perforation: extraluminal gas (97%), fluid or fat stranding along the gastroduodenal region (89%), ascites (89%), focal wall defect and/or ulcer (84%), and wall thickening (72%). Of these features, a wall defect and/or ulcer showed a positive likelihood ratio for gastroduodenal perforation of 36.83 and wall thickening showed a positive likelihood ratio of 10.52. Combined, these two features showed 95% sensitivity and 93% specificity for localization of a site of perforation [11]. If oral contrast is administered, extraluminal contrast may be seen at the site of perforation [8].
Epigastric Pain. Findings suggestive of the diagnosis of gastritis or PUD on CT can include the following: gastric or duodenal wall thickening due to submucosal edema; mucosal hyperenhancement or fat stranding due to inflammation; fluid along the gastroduodenal region; focal outpouching of the mucosa resulting from ulcerations; focal interruption of mucosal enhancement resulting from an ulcer crater eroding through the epithelial lining of the mucosal layer into the submucosal layer or muscularis propria; focal perforation of a gastric ulcer with associated free air; or gastric outlet obstruction due to edema or chronic inflammatory changes near the antrum and pylorus [7,8]. Active bleeding from a peptic ulcer can be detected when hyperdense blood products accumulate at the site of the ulcer or in the stomach/duodenal lumen or as an area of active contrast extravasation [8]. PUD is the main cause of nontraumatic gastroduodenal perforation [11]. In a study by Lee et al [11], the following features were seen with perforation: extraluminal gas (97%), fluid or fat stranding along the gastroduodenal region (89%), ascites (89%), focal wall defect and/or ulcer (84%), and wall thickening (72%). Of these features, a wall defect and/or ulcer showed a positive likelihood ratio for gastroduodenal perforation of 36.83 and wall thickening showed a positive likelihood ratio of 10.52. Combined, these two features showed 95% sensitivity and 93% specificity for localization of a site of perforation [11]. If oral contrast is administered, extraluminal contrast may be seen at the site of perforation [8].