Ulcer Healing and Scarring
The radiologic appraisal of ulcer mend is significant for evaluating the success or failure of checkup therapy and for confirming the presence of benign ulcer disease ( see former, “ Benign Versus Malignant Ulcers ” ). Ulcer healing may be manifested on barium studies not only by a decrease in the size of the ulcer volcanic crater but besides by a change in its condition. previously round or ovoid ulcers frequently have a linear appearance on follow-up studies, then analogue ulcers presumably represent a degree of ulcer bring around ( Fig. 29-13 ) .68,69 other ulcers may undergo cleave, so the ulcer crater is replaced by two separate niches at the periphery of the original ulcer ( Fig. 29-14 ) .69 This phenomenon most probable happen because healing and re-epithelialization are more rapid in the central fortune of the ulcer than in the periphery. Benign gastric ulcers normally have a marked reception to treatment with antisecretory agents. The average interval between the initial barium study showing the ulcer and the follow-up study showing arrant curative is about 8 weeks.69 Follow-up studies to demonstrate ulcer bring around should consequently be performed after 6 to 8 weeks of aesculapian treatment because studies performed sooner are improbable to show complete bring around.
In general, complete radiologic curative of a gastric ulcer has been considered a dependable sign that the ulcer is benign. rarely, complete curative of malignant ulcers may occur with medical therapy.89,90 however, nodularity of the ulcer scar or irregularity, clubbing, or amputation of radiating folds should suggest the possibility of an underlying malignant tumor. The surrounding gastric mucous membrane must therefore be evaluated carefully after ulcer mend has occurred. If leery findings are present, endoscopy and biopsy are hush required to rule out a malignant lesion.
Ulcer healing may lead to the development of ulcer scars, which are visible on double-contrast studies in 90 % of patients with cured gastric ulcers.69 These scars are normally manifested by a central pit or depression, radiating folds, and/or retraction of the adjacent gastric wall.69,91,92 The location of the ulcer is a major deciding of the morphologic features of the scratch. Healing of ulcers on the lesser curvature is often associated with the development of relatively innocuous scars, manifested by flimsy flatten or retraction of the adjacent gastric wall ( Fig. 29-15 ) .69,91 In line, heal of ulcers on the greater curvature or buttocks wall is sometimes associated with the development of a spectacular solicitation of radiating folds ( Fig. 29-16 ) .69,81,91 The folds may converge to a cardinal point or to a round or linear pit or depression ( Fig. 29-17 ) .69,91,92 This cardinal natural depression can be mistaken radiographically for a shallow, residual ulcer crater. however, the central low of an ulcer scratch tends to have more gradually sloping margins than an ulcer crater and should remain unaltered on consecutive follow-up studies. A re-epithelialized ulcer scar can besides be differentiated from an active ulcer by the presence of normal areae gastricae within the central share of the scratch ( Fig. 29-18 ) .69
Healing of antral ulcers may besides lead to the development of a outstanding cross fold that can be mistaken for an antral world wide web or diaphragm.91 In other patients, dangerous scar formation may be manifested by antral constricting and deformity ( Fig. 29-19A ). The pin down segment normally has a smooth, tapered appearance, but asymmetrical scar may result in flatten and shorten of the lesser or greater curvature, so the pylorus has an eccentric location in relation to the antrum and duodenal bulb ( Fig. 29-19B ). occasionally, an ulcer scratch may be associated with such irregular antral tapered that it mimics the linitis plastica appearance of a primary scirrhous carcinoma of the stomach.93 When antral scar can not be differentiated from a scirrhous carcinoma on radiologic criteria, endoscopy and biopsy are required for a more definitive diagnosis. Healing of ulcers on the lesser curvature of the gastric body may besides lead to punctuate retraction and disfigurement of the opposite wall, producing a bass incisure on the greater curvature.91,92 rarely, scarring of the gastric body may result in the exploitation of a alleged hourglass stomach with mark circumferential constricting of the gastric body ( Fig. 29-19C ) .