Available online at http://www.biij.

org/2010/4/e39
doi: 10.2349/biij.6.4.e39

biij
Biomedical Imaging and Intervention Journal
CASE REPORT

Carcinoma of stomach detected by routine transabdominal

ultrasound
Wong MFE*,1, Shum SFJ1, Chau WK2, Cheng CS1
1 Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
2 Department of Radiology, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

Received 4 March 2010; received in revised form 13 September 2010; accepted 22 September 2010

ABSTRACT

Assessment of the stomach is not commonly included in routine scanning protocol of upper abdominal ultrasound
(USG). However, assessment of the stomach in patients presenting with epigastric pain can yield invaluable results. This
paper presents, as an illustration, a case of carcinoma of stomach detected by transabdominal ultrasound. The diagnosis
is confirmed by subsequent CT, upper endoscopy and operation. © 2010 Biomedical Imaging and Intervention Journal.
All rights reserved.

Keywords: Limb salvage rate, lower limb vascular disease pattern, diabetics, Asian centre, percutaneous angioplasty

CASE REPORT operation and gastric adenocarcinoma wass confirmed at

laparotomy.
A 56-year-old gentleman with good past health
presented with epigastric pain and dysphagia for 1 month.
He was referred for an elective ultrasound examination. DISCUSSION
Transabdominal ultrasound showed nodular and
irregular wall thickening of the gastric antrum, The normal appearance of the stomach is illustrated
measuring up to 1.19cm in thickness. There was also in Figure 3. Three distinctive layers can usually be seen
associated loss of wall stratification (Figure 1). Small in a transabdominal ultrasound. The mucousa and
amounts of peritoneal fluid in the left subhepatic space submucousa appears hyperechoic, muscularis propria is
was also seen. Other findings included a small hypoechoic and subsererosa is hyperechoic. In
gallbladder polyp and small gallstones. endoscopic ultrasound, resolution of the gastric wall into
CT done after the ultrasound examination showed five layers may be seen but that is beyond the scope of
irregular wall thickening in the gastric antrum and body this discussion.
(Figure 2). Adjacent peritoneal fat stranding and Loss of wall stratification has been shown to be a
nodularity were also present, which is suggestive of sign of gastric malignancy [1]. This may be accounted
disease invasion and lymphadenopathy. for by the invasiveness of the disease process itself, in
The patient subsequently underwent elective which the tumour invades across different layers.
Gastric wall thickening without loss of wall
* Corresponding author. Present address: Department of Radiology, stratification favours a benign process, such as gastric
Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai ulcer, Menetrier’s disease and anisakiasis.
Wan, Hong Kong. Tel.: +852-96279537; Fax: +852-30074708;
E-mail: [email protected] (Wong Man Fung, Esther).
Wong et al. Biomed Imaging Interv J 2010; 6(4):e39 2
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Figure 3 Transverse scan of the upper abdomen of a normal

patient. Ring down artifacts (arrows) are suggestive of
intraluminal gas in the stomach. Different layers of
stomach: 1. echogenic mucousa and submucousa; 2.
hypoechoic muscularis propria; and 3. echogenic
subserosa.

Apart from loss of wall stratification, the degree of

gastric wall thickening also gives a clue to the nature of
underlying disorder. The sonographic thickness of
normal gastric body and antral wall measures up to 5mm
in a non-distended state [2]. Wall thickening of a lesser
extent (5-8mm) favours benign causes, such as chronic
Figure 1 a) Transverse scanning of the upper abdomen of the gastritis and gastric ulcer.[3]. In malignant causes, the
patient. Nodular and irregular thickening of the gastric degree of thickening is greater, with average thickness
antrum with loss of wall stratification (arrows); b) reported to be 15.9 mm in a study [4].
Transverse scan of the upper abdomen after patient In a healthy population, visualisation of the gastric
takes in water. Wall thickening up to 1.19 cm.
antrum has been reported to be up to 100%, while the
body and fundus is less consistently seen [5].
Transabdominal ultrasound examination has also been
shown to have high efficacy in visualising gastric
carcinoma [6]. Despite these promising results, however,
the detection of gastric tumours in real life practice
depends on patient habitus, location and staging of the
gastric tumour.
In most centres, routine scanning protocol of the
upper abdomen includes the liver, gallbladder, pancreas,
kidneys and spleen. Little attention has been paid to the
stomach. It is a common belief among sonographers and
radiologists that gastric pathology cannot be picked up
by ultrasound. Indeed, some part of the gastric wall may
be obscured by intraluminal gas. However, ingestion of
water just before the examination will help to displace
intraluminal gas and provide an acoustic window for
visualisation of the posterior wall.
Another limitation in transabdominal ultrasound is
in the detection of early mucousal lesions. Early tumours
that have not yet reached the stage of frank submucousal
invasion and formed a reasonable tumour bulk may not
be readily picked up by transabdominal ultrasound. In
such cases, patients with a negative ultrasound finding
but with relevant symptoms should not be deferred for
endoscopy. However, frank gastric pathology such as the
one illustrated in this case study should be picked up
during routine ultrasound, which will guide further
patient management.
Figure 2 Complementary plain CT of the patient confirms In summary, the authors recommend that attention
thickening of the stomach wall. Adjacent peritoneal
stranding and nodularity (arrows) is seen, which is be paid to gastric wall pathology during routine scanning
suggestive of disease invasion. for patients with relevant symptoms.
Wong et al. Biomed Imaging Interv J 2010; 6(4):e39 3
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