Presentation
Abdominal discomfort.
Patient Data
Lobulated soft tissue mass between the proximal third portion of the duodenum and IVC, will loss of tissue planes. Minor thickening of the duodenum without a clear intraluminal mass. Single enlarged anterior precaval lymph node indenting the lumen. No other sites of disease.
Case Discussion
Duodenal adenocarcinoma (biopsy and surgically proven) which invades the IVC, presenting on CT with a largely exophytic mass interposed between the third portion of the duodenum and IVC. There is relatively subtle mucosal thickening related to the primary tumor, but this is hard to detect compared to the large extraluminal component. There is also a single enlarged metastatic regional lymph node. The imaging features overlap with IVC leiomyosarcoma. Based on the location, an endoscopic biopsy is the best approach for tissue diagnosis.
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