ARRS 2022 Abstracts

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E1761. Hungry for Cases: Multimodality Imaging of Acute Gastric Pathology
Authors
  1. Kaustubh Shiralkar; University of Texas Houston Health Science Center
  2. Amir Khadivi; University of Texas Houston Health Science Center
  3. Michelle Kilcoyne; Texas Tech University Health Science Center
  4. Leela Chaudhary; University of Texas Houston Health Science Center
  5. Steven Chua; University of Texas Houston Health Science Center
Background
The clinical diagnosis of acute abdominal is often challenging and frequently elicits imaging in both emergent and non-emergent settings. Imaging plays an important role detecting and characterizing the etiology of acute abdominal pain, and radiologists will frequently encounter a variety of acute gastric pathologies. The purpose of our exhibit is to educate the reader and illustrate the various imaging appearances of acute gastric pathology.

Educational Goals / Teaching Points
The goals of this exhibit are to illustrate normal gastric anatomy; describe the significance of acute gastric pathology; review differential diagnosis of acute gastric pathologies; and discuss imaging features and pathophysiology of various gastric emergencies based into six categories: gastritis, trauma, bleeding, dilation, ischemia, and iatrogenic complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Epigastric pain, nausea, and vomiting are common presenting symptoms of acute gastric pathology, but these are nonspecific and may be overlooked clinically. CT is widely available, rapid, and superior in detecting acute gastric pathology. Upper GI and endoscopy are recommended for evaluation in outpatient or non-emergent situations. Radiographs are useful in evaluating potential foreign body ingestions/bezoar. It is important to scrutinize the stomach carefully in a patient with acute abdominal pain. Evaluation of reformatted CT images is also critical to avoid missing subtle disease. A variety of benign and malignant entities can result in gastric outlet obstruction. Gastric hemorrhage can be seen in a variety of diseases including peptic ulcer disease, tumor, varices, and arteriovenous malformations. Look for a hyperdense layering clot or active arterial blush on CT angiogram to evaluate for active bleeding. Gastric ischemia is relatively rare, as the stomach has extensive collateral blood supply.

Conclusion
Proper diagnosis of acute abdominal pain is essential to direct appropriate treatment due to its multitude of causes. Acute gastric pathology can sometimes be overlooked on imaging and therefore it is important for the radiologist to be keenly aware of the variety of pathologic conditions that can affect the stomach. The goal of this exhibit is to facilitate proper diagnosis of acute gastric pathology to improve diagnostic acumen and ultimately patient care.