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AJR Teaching File: Persistent Epigastric Pain

R. Mark Shideler1, Kevin P. Banks2 and Ernesto Torres2

1 Third Medical Group, 24800 Hospital Dr., Elmendorf Air Force Base, AK 99506-3700.
2 Department of Radiology, Brooke Army Medical Center, MCHE-DR, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234.


Figure 1
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  		Fig. 1A —41-year-old woman with epigastric pain on food intake that is relieved with antacids. Fluoroscopic image from upper gastrointestinal barium series shows moderate-sized, relatively smooth filling defect (arrows) along lesser curvature of stomach. Note also large irregular marginated mass (arrowheads) involving greater curvature. Adjacent rugal folds are distorted.

 

Figure 2
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  		Fig. 1B —41-year-old woman with epigastric pain on food intake that is relieved with antacids. Fluoroscopic findings of irregular mass (arrows) persist with repositioning. Peristalsis in these regions is markedly abnormal (seen during real-time imaging).

 

Figure 3
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  		Fig. 1C —41-year-old woman with epigastric pain on food intake that is relieved with antacids. CT scan of abdomen after administration of oral contrast agent reveals 6-cm circumferential mass involving distal stomach. Mass infiltrates wall and has both intraluminal and extraluminal extensions. Lesion has lobulated or nodular margin and enhances heterogeneously. Gastric fold pattern is distorted.

 

Figure 4
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  		Fig. 1D —41-year-old woman with epigastric pain on food intake that is relieved with antacids. Delayed CT image obtained with patient in prone position shows similar appearance and persistence of marked wall thickening.

 

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