What causes the Antral Pad Sign in the stomach on upper gastrointestinal contrast radiography?
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Answer:
The antral pad sign is a radiographic observation on upper gastrointestinal contrast radiography where there is indentation or contour irregularity of the distal gastric antrum. This is caused by extrinsic soft tissue, such as the liver or pancreas, compressing or abutting the gastric antrum, leading to a cushioned appearance on imaging. Differential diagnoses for the antral pad sign include chronic pancreatitis, pancreatic tumors, or hepatic tumors, as these conditions may displace or compress the gastric antrum.
Why is it called so?
The term “antral pad” refers to the impression of a soft, pad-like structure indenting the antral region of the stomach. The word “pad” underscores the cushioning effect of the adjacent organ mass, while “sign” indicates its role as a recognizable radiographic marker on contrast radiography.
Pathophysiology
The antral pad sign develops when an adjacent visceral mass—such as an enlarged pancreas in chronic pancreatitis or a pancreatic neoplasm—or hepatic enlargement exerts pressure on the distal gastric antrum. This extrinsic compression deforms the antral wall, which becomes outlined by intraluminal contrast during the upper gastrointestinal series. On imaging, it appears as a smooth, concave impression against the antrum, reflecting the interface between the stomach and the compressed organ.
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