Imaging description

Pseudothickening can affect any segment of the bowel.

Two locations in the stomach commonly mimic bowel wall thickening. More proximally, in the region of the gastroesophageal junction and gastric cardia, there may be a transient area of apparent thickening (Figure 61.1). This is usually seen at the level of the ligamentum venosum [1]. A second common location of gastric pseudothickening is in the gastric antrum. This is present in the majority of patients undergoing CT [2]. Antral contractions increase the wall thickness to 5 to 10 mm in most patients, but in 5% of normal patients, it will exceed 1 cm [2]. Gastric wall thickening of 1 cm or more has been found to be sensitive but not specific for the diagnosis of malignant lesions (Figure 61.2) [3]. Moreover, localized antral wall thickening has been found to be a poor predictor of subclinical Helicobacter pylori infection [4]. However, if there are inflammatory changes in the surrounding fat, or heterogeneous enhancement, underlying disease such as gastritis or malignancy should be suspected.