Differential diagnosis of benign ulcer and malignant ulcer Radiographic Signs of a benign gastric ulcer Ulcer crater-collection of barium on dependent surface which usually projects beyond anticipated wall of stomach in profile(penetration) Hampton's line-1 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa. Ulcer collar-smooth,thick,lucent band at neck of ulcer in profile view representing thicker rim of edematous gastric wall. Uleer mound-smooth,sharply delineated tissue mass surrounding a benign ulcer. Ring shadow-thin rim of contrast which represents an ulcer on the on-dependent surface of an air-contrast study. Thickened folds radiatingdirectly to the base of the ulcer en face Radiographic signs of malignant ulcers Ulcer projects within the anticipated wall of the stomach Ulcer is eccentrically located within the ulcer mound Irregularly shaped ulcer crater ■Nodular ulcer mound Abrupt transition between normal and abnormal mucosa several cms away from the ulcer crater Rigidity,lack of distensibility and lack of changeability ■Associated large mass Carmen meniscus sign-a relatively shallow gastric ulcerating malignancy projecting as an ulcer which is always convex inwards to the lumen and which does not project beyond the wall=Kirklin meniscus complex 3 3 Differential diagnosis of benign ulcer and malignant ulcer Radiographic Signs of a benign gastric ulcer Ulcer crater-collection of barium on dependent surface which usually projects beyond anticipated wall of stomach in profile (penetration) Hampton’s line-1 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa. Ulcer collar-smooth, thick, lucent band at neck of ulcer in profile view representing thicker rim of edematous gastric wall. Ulcer mound-smooth, sharply delineated tissue mass surrounding a benign ulcer. Ring shadow-thin rim of contrast which represents an ulcer on the non-dependent surface of an air-contrast study. Thickened folds radiating directly to the base of the ulcer en face. Radiographic signs of malignant ulcers ◼ Ulcer projects within the anticipated wall of the stomach ◼ Ulcer is eccentrically located within the ulcer mound ◼ Irregularly shaped ulcer crater ◼ Nodular ulcer mound ◼ Abrupt transition between normal and abnormal mucosa several cms away from the ulcer crater ◼ Rigidity, lack of distensibility and lack of changeability ◼ Associated large mass ◼ Carmen meniscus sign-a relatively shallow gastric ulcerating malignancy projecting as an ulcer which is always convex inwards to the lumen and which does not project beyond the wall=Kirklin meniscus complex 20’ 20’