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Case 52 - Pseudomass due to duodenal diverticulum

from Section 8 - Retroperitoneum

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

Duodenal diverticula are congenital anatomic variants and are found in up to 22% of the population at autopsy [1]. Fluid-filled or collapsed duodenal diverticula may mimic cystic or soft-tissue retroperitoneal or pancreatic masses at cross-sectional imaging (Figures 52.1–52.3) [2,3]. Increased uptake of FDG within a duodenal diverticulum at PET imaging has also been reported [4].

Importance

Misdiagnosis of retroperitoneal adenopathy or a pancreatic mass may result in unnecessary surgery or treatment [2].

Typical clinical scenario

Duodenal diverticula are incidental findings that are likely to cause most diagnostic confusion when seen in patients with known malignancy (when they may suggest metastatic spread) or in the postoperative period (when they may resemble an abscess).

Differential diagnosis

Duodenal diverticula can usually be diagnosed by recognizing the characteristic location near the duodenum and by examination of all available studies that may allow identification of intradiverticular air [3].

Teaching point

The possibility of a duodenal diverticulum should be considered when an apparent cystic or soft-tissue mass or collection is seen adjacent to the duodenum. Comparison with prior studies or repeat examination after oral contrast may facilitate correct diagnosis.

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
 , pp. 178 - 179
Publisher: Cambridge University Press
Print publication year: 2010

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References

Lipsett, P. Diverticular disease of the small bowel. In: Cameron, JL, ed. Current surgical therapy, 6th edition. St. Louis, MO: Mosby, 1998; 148–150.Google Scholar
Hariri, A, Siegelman, SS, Hruban, RH. Duodenal diverticulum mimicking a cystic pancreatic neoplasm. Br J Radiol 2005; 78: 562–564.CrossRefGoogle ScholarPubMed
Macari, M, Lazarus, D, Israel, G, Megibow, A.Duodenal diverticula mimicking cystic neoplasms of the pancreas: CT and MR imaging findings in seven patients. Am J Roentgenol 2003; 180: 195–199.CrossRefGoogle Scholar
Piesman, M, Hwang, I, Moses, FM, Allen, TW. Duodenal diverticulum presenting as a hypermetabolic mass on F-18 FDG PET/CT. Clin Nucl Med 2005; 30: 747–748.CrossRefGoogle ScholarPubMed

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