Dieulafoy Lesion Diagnosis and Characteristics

Endoscopic Appearance and Location

The American College of Gastroenterology notes that a Dieulafoy lesion appears as an arteriole protruding through a small mucosal defect, typically 1-3 mm in diameter, and may be actively spurting blood or show a visible vessel in the absence of active bleeding 1

The American College of Gastroenterology recommends repeated endoscopy if initial examination is negative, as the lesion's small size and hidden location make it a diagnostic challenge 1
Dieulafoy lesions are among the most frequently missed lesions in the upper gastrointestinal tract, along with Cameron's erosions, fundic varices, and angiectasias, with younger patients more likely to have Dieulafoy lesions as a cause of bleeding compared to older patients 2

The American College of Radiology states that Dieulafoy lesions are associated with very high mortality rates if not promptly identified and treated, with overall mortality ranging from 10-17% 3

CT angiography can demonstrate Dieulafoy lesions, which are most conspicuous on arterial phase imaging, and multiphase CT enterography may be helpful when the lesion is beyond the reach of standard endoscopy 1, 3
The American College of Radiology recommends CTA as a useful tool in hemodynamically unstable patients or when endoscopy fails to localize the bleeding source 1, 3