Fig. 20

Lymphoma. Contrast-enhanced CT (a, b) shows homogeneous and asymmetric thickening of the duodenal wall with mild dilatation of the lumen (arrows); there is biliary and Wirsung duct dilatation (arrowheads); paraduodenal adenopathy is also evident (asterisks). UGIS of the same patient (c) shows loss of the normal mucosal pattern of folds at the descending duodenum (arrows). UGIS some months after the first UGIS, while on chemotherapy (d) shows abrupt luminal narrowing at the horizontal duodenum (arrow), with dilatation of the proximal duodenal segments. Because of increased pressure at the stenosis, there was contrast reflux to the biliary ducts and Wirsung duct (arrowheads)