Small Intestine

GIST may occur anywhere throughout the small intestine, and these patients usually present with signs and symptoms of bowel obstruction. At CT, GISTs may appear as an intra mural polyp or intraluminal mass. Tumor margins are typically well defined, unless they have mucosal ulcerations. Tumors may also cavitate and form fistulous communication with surrounding bowel loops. Similar to gastric GISTs, tumors typically enhance with central areas of low attenuation due to hemorrhage, necrosis, or cyst formation (Figure 30.6). Homogeneous pattern of enhancement is less common. Tumors may encase or invade surrounding small bowel, colon, urinary bladder, or ureter. Patients may also present

figure 30.5. Incidental submucosal gastric leiomyoma simulating GIST in a 56-year-old man. (A) Axial contrast-enhanced CT of the abdomen reveals a small submucosal soft tissue mass in the fundus of the stomach (arrow). The homogeneous enhancement and lack of exophytic component favor the diagnosis of leiomyoma over GIST. (B) Coronal volume-rendered image better demonstrates the smooth contour of the lesion (arrow) and the intact overlying mucosa.

figure 30.5. Incidental submucosal gastric leiomyoma simulating GIST in a 56-year-old man. (A) Axial contrast-enhanced CT of the abdomen reveals a small submucosal soft tissue mass in the fundus of the stomach (arrow). The homogeneous enhancement and lack of exophytic component favor the diagnosis of leiomyoma over GIST. (B) Coronal volume-rendered image better demonstrates the smooth contour of the lesion (arrow) and the intact overlying mucosa.

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