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4. Turning the patient supine will open the aortic-SMA angle in some patients. Cross-Reference Gastrointestinal Imaging: THE REQUISITES, ed 3, p 90. Comments The transverse retroperitoneal portion of the duodenum is nestled in an angle created by the aorta posteriorly and the superior mesenteric artery anteriorly. This angle can vary in size and hence this condition is sometimes controversial. There are some who refuse to accept that SMA syndrome is a real condition. Given the narrowness of the angle we are now able to measure on MDCT sagittal images in asymptomatic patients, this is quite understandable.

Adenomyomatosis. 4. Peptic ulcer disease, gastric outlet obstruction, and pulmonary disease. Cross-Reference Gastrointestinal Imaging: THE REQUISITES, ed 3, p 246. Comments Although calculi are by far the most common cause of filling defects within the gallbladder, several noncalculous lesions can produce filling defects within the gallbladder lumen. One of the more common noncalculous causes is a gallbladder polyp. Polyps in the gallbladder produce echogenic filling defects within the lumen but are fixed, often along the nondependent surface of the gallbladder.

What are the findings in the barium image and CT image of the upper abdomen? 2. What is the most common malignant lesion of the small bowel? 3. How does the right kidney affect the duodenum? 4. What is the most common cause for duodenal inflammation? 33 A N S W E R S CASE 18 Duodenal Narrowing Secondary to Pancreatitis 1. Narrowing and spasm of the second portion of the duodenum. Note lack of proximal dilatation. The CT images show thickened duodenal folds through this area. 2. Lymphoma. 3. The right kidney abuts the duodenum at the junction of the descending and transverse portions of the retroperitonel duodenum.

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