Intraluminal Duodenal Diverticulum: The Windsock Sign

HomeRadiologyVol. 300, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyIntraluminal Duodenal Diverticulum: The Windsock SignRaquel C. S. Gaio , Luís M. B. VítorRaquel C. S. Gaio , Luís M. B. VítorAuthor AffiliationsFrom the Department of Radiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, E.P.E., Avenida Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal.Address correspondence to R.C.S.G. (e-mail: [email protected]).Raquel C. S. Gaio Luís M. B. VítorPublished Online:Jun 29 2021https://doi.org/10.1148/radiol.2021204576MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Online supplemental material is available for this article.A 21-year-old man presented with an approximately 1-year history of intermittent episodes of early satiety and postprandial epigastric pain associated with vomiting. The pain was of rapid onset and resolved after vomiting. Relevant history included chronic thrombosis of the extrahepatic portal vein of unknown cause, with cavernous transformation and portal hypertension. Upper gastrointestinal endoscopy showed severe stenosis of the second portion of the duodenum. Abdominal CT was performed without administration of oral contrast material because of patient intolerance, and findings were suspicious for an intraluminal duodenal mass (Figure). Images from upper gastrointestinal series showed findings compatible with an intraluminal duodenal diverticulum (Figure, Movie [online]). The patient refused surgical excision of the diverticulum and elected for watchful waiting of his condition.Images in 21-year-old man who presented with approximately 1-year history of intermittent episodes of early satiety and postprandial epigastric pain associated with vomiting. A, Contrast-enhanced maximum intensity oblique coronal CT image shows collapsed intraluminal duodenal diverticulum (orange arrow) as elongated intraluminal flap of similar attenuation to duodenal wall. Extrahepatic portosystemic collateral vessels, which are dilated branches of superior mesenteric vein (white arrows), and splenorenal shunt (green arrow) are also shown. B, Axial CT angiogram shows diverticulum (orange arrow), which simulates an intraluminal mass. Retroaortic left renal vein (blue arrow) is also shown. C, D, Sequential right anterior oblique radiographs of upper gastrointestinal tract after barium ingestion show, C, filling and, D, subsequent emptying of sac-like diverticulum (*). Radiolucent line (arrows) represent mucosal web, which separates contrast material within diverticulum from contrast material in peripheral true duodenal lumen.Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Movie of upper gastrointestinal tract after barium ingestion. Sequential right anterior oblique radiographs of upper gastrointestinal tract after barium ingestion show progressive filling and emptying of sac-like diverticulum.Download Original Video (.6 MB)The "windsock sign" refers to the appearance of the intraluminal duodenal diverticulum on images from upper gastrointestinal barium series (1), but it is similar at abdominal CT and MRI (2) when the diverticulum is distended. As in this case, a collapsed diverticulum can simulate an intraluminal mass at CT (3). Patients with this rare congenital condition can present with a wide range of clinical symptoms, ranging from gastric outlet obstruction and epigastric pain to peptic ulcer disease, recurrent pancreatitis, and cholangitis (1). The typical imaging appearance allows the radiologist to suggest the diagnosis.Disclosures of Conflicts of Interest: R.C.S.G. disclosed no relevant relationships. L.M.B.V. disclosed no relevant relationships.References1. Materne R. The duodenal wind sock sign. Radiology 2001;218(3):749–750. Link, Google Scholar2. Takamatsu S, Gabata T, Matsui O, Noto M, Ninomiya I, Nonomura A. Intraluminal duodenal diverticulum: MR findings. Abdom Imaging 2006;31(1):39–42. Crossref, Medline, Google Scholar3. Fidler JL, Saigh JA, Thompson JS, Habbe TG. Demonstration of intraluminal duodenal diverticulum by computed tomography. Abdom Imaging 1998;23(1):38–39. Crossref, Medline, Google ScholarArticle HistoryReceived: Dec 20 2020Revision requested: Jan 19 2021Revision received: Jan 26 2021Accepted: Jan 29 2021Published online: June 29 2021Published in print: Sept 2021 FiguresReferencesRelatedDetailsCited ByIDKD Springer SeriesLaura S.Kox, Anne M. J. B.Smets, Thierry A. G. 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