Table 5.

Frequent causes of UGIB: clinical presentation and CT findings.

UGIB DUE TO VARICES
	Clinical Presentation	CT Findings
Oesophageal-gastric varices due to portal hypertension (Figure 21)	Asymptomatic until they rupture in the oesophageal lumen and cause haematemesis or melaena or haematochezia depending on the severity of the bleeding.	Tortuous, enlarged, smooth tubular structures protruding into the oesophageal lumen or adjacent to the internal oesophageal mucosa.
NON-VARICEAL NON-VASCULAR CAUSES OF UGIB
	Clinical Presentation	CT Findings
Mallory–Weiss Tear (Figure 22)	A history of recent retching or haematemesis or “coffee grounds” emesis following violent vomiting, often after excessive alcohol consumption, and manifested by stabbing pain in the epigastrium and left side of the chest, radiating to the back.	Finding haemorrhagic spots or foci of extraluminal gas at the site of the mucosal laceration.
Oesophagitis (Figure 23)	Anaemia, retrosternal pain.	Diffuse oesophageal thickening, submucosal oedema and mucosal hyperaemia.
Oesophageal ulcer	Haematemesis, epigastric pain and odynophagia.	Thickening of the wall, peri-oesophageal gas and fluid collection, extraluminal contrast extravasation.
Oesophageal diverticulum (Figure 24)	Asymptomatic bleeding.	Haemorrhage in a focal herniation of the mucosa through a site of weakness in the muscle layer.
Peptic ulcer (Figure 25)	Manifestations range from asymptomatic to melaena or haematemesis, to hypovolaemic shock. Bleeding due to gastric ulcers often presents with haematemesis, while duodenal bleeding can present with tarry stools or even occasionally haematochezia, depending on the extent of bleeding.	Direct identification of active haemorrhage as extravasation of an intra-luminal “jet” or “blush” of contrast medium at the site of the haemorrhage, detected in the gastric fundus or duodenal lumen.
Neoplasia	Anaemia in a patient with a history of cancer.	A focal area of high attenuation within the bowel lumen that represents a bleeding point at the tumour site.
Gastrointestinal Stromal Tumour (GIST) (Figure 26)	Asymptomatic or bleeding.	Soft tissue density mass with variable areas of necrosis. They are usually highly vascularised and the enhancement of the lesion may vary from homogeneous to peripheral and irregular depending on the lesion dimension and grade of malignancy.
NON-VARICEAL VASCULAR CAUSES OF UGIB
	Clinical Presentation	CT Findings
Dieulafoy Lesion (Figure 27)	Melaena, haematemesis, haematochezia, or a combination of more than one of these signs, depending on the location of the lesion.	Abnormally enlarged submucosal vessel, which may appear tortuous, linear or as a non-specific “blush” of contrast medium at the mucosal/submucosal level.
Artero-Venous Malformations	Asymptomatic.	A tiny nidus of vascular potentiation appreciable in the arterial phase and often undetectable in the late phase. When associated with an early draining vein in the arterial phase, the lesion represents an AVM.
Aorto-Gastric Fistula (Figure 28)	Copious bleeding.	A connection between the aorta and the gastric lumen. Absence of adipose cleavage planes.
[23,24,25]