PMC5519402_01
Computed tomography showing gastric pneumatosis.
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F1
Given his initially high hemoglobin, abdominal computed tomography (CT) ordered to assess for renal masses showed gastric pneumatosis (Figure 1).
Initial endoscopy with significant gastric hemorrhage and necrosis.
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F2
These CT findings, in addition to the patient's clinical presentation, called for an upper endoscopy, which demonstrated significant hemorrhage and ulceration involving a large portion of the gastric cardia, fundus, and body (Figure 2).
Biopsy pathology showing (A) calcium phosphate deposits within the gastric vasculature (arrow, 600x), and (B) calcium phosphate deposits within the gastric vasculature (arrow, 400x).
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F3
Multiple biopsies revealed acute ulcerative gastritis and the presence of patchy intravascular calcium phosphate crystals (Figure 3).
Follow-up endoscopy with significant improvement in gastric mucosal injury approximately 4:6 weeks after initial presentation.
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F4
Repeat endoscopy 4 weeks after initial presentation demonstrated significant ulcer and gastric mucosal healing (Figure 4).
Biopsy pathology from follow-up endoscopy demonstrating gastric antral tissue and a lack of intravascular calcium phosphate deposits with newly formed capillaries (arrow, 600x).
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F5
Biopsies taken from this repeat endoscopy showed the absence of calcium deposits from his initial endoscopy (Figure 5).