Imaging Pearls ❯ Stomach ❯ Vascular Tumors
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- ACR Appropriateness Criteria on Upper Gastrointestinal Bleeding
- Technetium-99m labeled erythocyte scans are of limited value in diagnosing UGIB but remain useful in certain cases of obscure UGIB
- Variceal UGIB refractory to endoscopic management should be treated with TIPS insertion. Primary and secondary TIPS patency rates have impoved dramatically with the use of stent grafts rather than bare metal stents - ACR Appropriateness Criteria on Upper Gastrointestinal Bleeding
- All patients with presumed UGIB should first be examined by upper endoscopy
- Angiography and embolization should be considered for all patients with a known source of arterial UGIB refractory to endoscopic management for those with brisk, active bleeding and negative results on endoscopy
- CT is particularly useful for the localizing of obscure UGIB and in the workup of a patient with UGIB and a history of aortic reconstruction or pancreaticobiliary procedure - Upper GI Bleed (UGIB): Facts
- 70-80% of cases will cease spontaneously
- Upper endoscopy is the study of choice and will detect the source of hemorrhage in 95% of cases and provides prognostic information regarding rebleeding, the need for surgery, the level of care required and mortality
- Endoscopy typically can provide diagnosis and therapy ( injection of sclerosants, thermal coagulation techniques and mechanical methods like band ligation and clips) - Upper GI Bleed: Common Causes per Endoscopy
- Duodenal ulcer (24.3%)
- Gastric erosions (23.4%)
- Gastic ulcer (21.3%)
- Varices (10.3%)
- Mallory-Weiss tear (7.2%)
- Esophagitis (6.3%)
- Duodenitis (5.8%)
- Neoplasms (2.9%) - Upper GI Bleed: Facts
- Definition: bleeding source is proximal to the ligament of Treitz so originates from the esophagus, stomach or duodenum
- Incidence in USA is between 36 and 48 per 100,000 persons annually
- Most common etiology is a duodenal ulcer (24.3%) - Glomus Tumors: Facts
- GI glomus tumors are nearly always in the stomach
- Represent under 2% of all benign gastric tumors
- Usually under 3 cm in size
- Very vascular especially on arterial phase imaging - GIST Tumors: Facts Site of origin
- Stomach 60-70% of cases
- Small bowel 30% of cases
- Rectum, esophagus, colon and appendix are rare sites of tumor "A subepithelial mass, which was previously called a submucosal mass, is defined as a mass covered with normal appearing mucosa, whether the underlying process is intramural or extramural in origin."
Hypervascular Subepithelial Gastrointestinal Masses: CT-Pathologic Correlation
Lee NK et al.
RadioGraphics 2010; 30:1915-1934- Hypervascular Subepithelial GI Masses: Differential Dx
- Neuroendocrine tumors
- GI stromal tumors
- Glomus tumor
- Hemangioma
- Angiosarcoma
- Kaposi sarcoma
- Hypervascular metastases
- Heterotopic tissues
- Vascular structures