Multidetector CT enterography of focal small bowel lesions: a radiological–pathological correlation
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Focal small bowel lesions present a diagnostic challenge for both the radiologist and gastroenterologist. Both the detection and characterization of small bowel masses have greatly improved with the advent of multidetector CT enterography (MD-CTE). As such, MD-CTE is increasingly utilized in the workup of occult gastrointestinal bleeding. In this article, we review the spectrum of focal small bowel masses with pathologic correlation. Adenocarcinoma, the most common primary small bowel malignancy, presents as a focal irregular mass occasionally with circumferential extension leading to obstruction. Small bowel carcinoid tumors most commonly arise in the ileum and are characterized by avid enhancement and marked desmoplastic response of metastatic lesions. Aneurysmal dilatation of small bowel is pathognomonic for lymphoma and secondary findings of lymphadenopathy and splenomegaly should be sought. Benign small bowel masses such as leiomyoma and adenoma may be responsible for occult gastrointestinal bleeding. However, primary vascular lesions of the small bowel remain the most common cause for occult small bowel gastrointestinal bleeding. The arterial phase of contrast obtained with CTE aids in recognition of the vascular nature of these lesions. Systemic conditions such as Peutz–Jeghers syndrome and Crohn’s disease may be suggested by the presence of multiple small bowel lesions. Lastly, potential pitfalls such as ingested material should be considered when faced with focal small bowel masses.
KeywordsCT enterography Focal small bowel
Compliance with ethical standards
No funding was received for this study.
Conflicts of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
- 5.Huprich J, Fletcher J, Fidler J (2011) Obscure GI bleeding: the role of multiphase CT enterography. Appl Radiol. Accessed at 4 Feb 2015 from http://appliedradiology.com/articles/obscure-gi-bleeding-the-role-of-multiphase-ct-enterography#sthash.IKrG1APQ.dpuf.
- 12.Iacobuzio-Donahue, CA. II, Montgomery, E. Gastrointestinal and liver pathology. Copyright © 2012, 2005 by Saunders, an imprint of Elsevier Inc.Google Scholar
- 31.Xynopoulos D, Mihas A, Paraskevas E, Dimitroulopoulos D, et al. (2002) Small bowel tumors. Ann Gastroenterol 15:18–35Google Scholar
- 35.Savides TJ, Jensen DM (2010) Gastrointestinal bleeding. In: Feldman M, Frience S, Brandt LJ (eds) Sleisenger and Fordtran’s gastrointestinal and liver disease, 9th edn. Philadelphia: Elsevier MedicineGoogle Scholar
- 39.Singh AK, Federman DD (2015) Scientific American medicine. Ontario/Philadelphia: Decker Electronic Publishing, Inc.Google Scholar
- 69.Grendell JH, Ermak TH (1998) Anatomy, histology, embryology, and developmental anomalies of the pancreas. In: Felman M, Friedman L, Brandt L (eds) Sleisenger & Fordtran’s gastrointestinal and liver disease. Philadelphia, PA: Saunders, pp 761–771Google Scholar