Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

General Research Article

Analysis of Missed Diagnosis of Gastric Lipomas by CT

Author(s): Long Xu, Xiao Dong Zhang, Chen Zeng and Han Feng Yang*

Volume 17 , Issue 7 , 2021

Published on: 25 February, 2021

Page: [911 - 915] Pages: 5

DOI: 10.2174/1573405617666210225094532

Price: $65

Abstract

Introduction: Although Computed Tomography (CT) is the most convenient technology for the diagnosis of gastric lipoma, it also has a high rate of missed diagnosis of gastric lipoma.

Objective: To analyze the causes of missed diagnosis of gastric lipomas by CT.

Methods: We retrospectively studied the CT images and CT diagnosis reports of 25 cases of gastric lipoma confirmed by surgery or clinical follow-up at the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital from 2016 to 2020 and analyzed the causes of missed diagnosis of gastric lipomas.

Results: Among the 25 cases of gastric lipomas included in this study, 17 cases (68.0%) were correctly diagnosed by CT, and 8 cases (32.0%) were missed, but there was no case of misdiagnosis. Eighteen cases (72.0%) of gastric lipomas were located in the gastric antrum, 2 cases (8.0%) at the junction of the gastric body and antrum, 5 cases (20.0%) at the fundus of the stomach, 23 cases (92.0%) under the gastric mucosa, and 2 cases (8.0%) under the gastric serous membrane. All gastric lipoma cases were manifested as round or oval-shaped low-density shadows with clear boundaries on CT. 22 cases (88.0%) showed homogeneous low-density shadows while 3 cases (12.0%) mainly showed low-density shadows containing medium-density strips. There was no obvious enhancement in the contrast-enhanced CT scan. The gastric lipoma cases missed by CT were all located under the gastric mucosa of the gastric antrum. When reading the CT images on the default upper abdominal window width and window level, all the missed lesions were similar to the gas image. And the straight meridian of the three lesions was less than 2 cm.

Conclusion: Fat density shadow in gastric antrum area was mistaken for gastrointestinal gas. Improper CT image window width and window levels and small gastric lipoma volume, along with insufficient knowledge of gastric lipomas imaging by the clinician, might be the main causes of missed diagnosis of gastric lipomas by CT. Familiarity with the CT manifestations of gastric lipomas and rich clinical experience can improve the rate of correct diagnosis of gastric lipomas by CT.

Keywords: Gastric lipomas, computed tomography, missed diagnosis, gastric antrum, CT window width, gastrointestinal gas.

Graphical Abstract
[1]
Neto FA, Ferreira MC, Bertoncello LC, et al. Gastric lipoma presenting as a giant bulging mass in an oligosymptomatic patient: A case report. J Med Case Reports 2012; 6: 317.
[http://dx.doi.org/10.1186/1752-1947-6-317] [PMID: 23006791]
[2]
Chagarlamudi K, Devita R, Barr RG. Gastric lipoma: A review of the literature. Ultrasound Q 2018; 34(3): 119-21.
[http://dx.doi.org/10.1097/RUQ.0000000000000338] [PMID: 29369244]
[3]
Sharma B, Dhakal O. Large gastric lipoma. Kathmandu University medical journal (KUMJ) 2012; 10(39): 70-2.
[4]
Krasniqi AS, Hoxha FT, Bicaj BX, et al. Symptomatic subserosal gastric lipoma successfully treated with enucleation. World J Gastroenterol 2008; 14(38): 5930-2.
[http://dx.doi.org/10.3748/wjg.14.5930] [PMID: 18855998]
[5]
Taylor AJ, Stewart ET, Dodds WJ. Gastrointestinal lipomas: A radiologic and pathologic review. AJR Am J Roentgenol 1990; 155(6): 1205-10.
[http://dx.doi.org/10.2214/ajr.155.6.2122666] [PMID: 2122666]
[6]
Thompson WM. Imaging and findings of lipomas of the gastrointestinal tract. AJR Am J Roentgenol 2005; 184(4): 1163-71.
[http://dx.doi.org/10.2214/ajr.184.4.01841163] [PMID: 15788588]
[7]
Chu AG, Clifton JA. Gastric lipoma presenting as peptic ulcer: case report and review of the literature. Am J Gastroenterol 1983; 78(10): 615-8.
[PMID: 6605087]
[8]
Kim DD, Tsai AI, Otani AR, Puglia CR, Malheiros CA. Gastric lipoma case report. Rev Col Bras Cir 2011; 38(3): 205-6.
[http://dx.doi.org/10.1590/S0100-69912011000300013] [PMID: 21789462]
[9]
Regge D, Lo Bello G, Martincich L, et al. A case of bleeding gastric lipoma: US, CT and MR findings. Eur Radiol 1999; 9(2): 256-8.
[http://dx.doi.org/10.1007/s003300050664] [PMID: 10101647]
[10]
Treska V, Pesek M, Kreuzberg B, Chudácek Z, Ludvíková M, Topolcan O. Gastric lipoma presenting as upper gastrointestinal obstruction. J Gastroenterol 1998; 33(5): 716-9.
[http://dx.doi.org/10.1007/s005350050160] [PMID: 9773937]
[11]
Tang SY, Huang Y, Zhang CL, Cheng C, Kuang LQ, Wang Y. Comparative study of MSCT, endoscopy and gastrointestinal tract radiography in diagnosis of gastric lipomas. Med J Chinese People’s Liber Arm 2017; 42(2): 154-7.
[12]
Chen QD, Zheng XW, Xu CY, Qiu QD. Multi slice spiral CT diagnosis of intestinal lipoma secondary intussusceptions. Chinese J Gen Surg 2017; 32(05): 402-5.
[13]
Winants D, Arnault G. Gastric lipoma. X-ray computed tomographic diagnosis. J Radiol 1989; 70(11): 633-6.
[PMID: 2614755]
[14]
Sullivan I, Hota P, Dass C. Gastric lipomas: A case series and review of a rare tumor. BJR case reports 2019; 5(2): 20180109.
[http://dx.doi.org/10.1259/bjrcr.20180109]
[15]
Imoto T, Nobe T, Koga M, Miyamoto Y, Nakata H. Computed tomography of gastric lipomas. Gastrointest Radiol 1983; 8(2): 129-31.
[http://dx.doi.org/10.1007/BF01948104] [PMID: 6852427]
[16]
Li SZ, Zhang JH, Li JC, Dong Z. Diagnosis and treatment of gastric lipoma: An analysis of 66 cases. World Chin J Digestology 2009; 17(35): 3649-52.
[http://dx.doi.org/10.11569/wcjd.v17.i35.3649]
[17]
Navarro-Vergara DI, Roldan-Valadez E, Cueto-Robledo G, Jurado-Hernandez MY. Portopulmonary hypertension: Prevalence, clinical and hemodynamic features. Curr Probl Cardiol 2020; 100747.
[http://dx.doi.org/10.1016/j.cpcardiol.2020.100747] [PMID: 33248724]
[18]
Ichinose M, Hikichi T, Kanno Y, et al. A case of gastric lipoma resected by endoscopic submucosa dissection with difficulty in preoperative diagnosis. Fukushima J Med Sci 2017; 63(3): 160-4.
[http://dx.doi.org/10.5387/fms.2016-19] [PMID: 28904301]
[19]
Turkington RW. Gastric lipoma; report of a case and review of the literature. Am J Dig Dis 1965; 10: 719-26.
[http://dx.doi.org/10.1007/BF02236072] [PMID: 14316760]
[20]
Krishnaraj B, Dhanapal B, Shankar G, Sistla SC, Galidevara I, Suresh A. Gastric lipoma: a rare cause of haematemesis. Ann R Coll Surg Engl 2018; 100(3): e41-3.
[http://dx.doi.org/10.1308/rcsann.2017.0209] [PMID: 29484931]
[21]
Sharayah A, Unnikrishnan DC, Perumangote Vasudevan AA, Hajjaj N, Raj R, Belitsis K. A rare case of gastric lipoma presenting with gastric outlet obstruction treated endoscopically. Case Rep Gastrointest Med 2019; 2019: 5749830.
[http://dx.doi.org/10.1155/2019/5749830] [PMID: 30906601]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy