Overview and CT Imaging Examples of Common Colon Pathologies
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Transcript of Overview and CT Imaging Examples of Common Colon Pathologies
Overview and CT Imaging Examples of Common Colon PathologiesAndy Nguyen
Kellie Schenk
Table of Contents• Normal anatomy• Appendicitis• Diverticulosis• Diverticulitis• Ulcerative colitis• Crohn’s disease• Pseudomembranous c
olitis (C. diff)• Adenocarcinoma
• Quiz cases• References
*You can navigate through the presentation linearly or click on any of the above links to jump to that specific section
Normal Anatomy
Return to Table of ContentsCT Abdomen, Axial view
Appendicitis
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Note enlargement of the appendix (arrows), intraluminal fluid, and adjacent inflammatory stranding
• Demographics:• Any age, most commonly
10-30 years old• Slightly more common in
males (1.4 : 1)
• Clinically:• Abdominal pain, often
RLQ• Nausea• Vomiting• Fever
Appendicitis (cont’d)
• Compare to normal appendix
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Normal air-filled appendix (arrow)
Diverticulosis
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Moderate diverticulosis in the sigmoid colon (arrows)
• Demographics:• Rare before age 40• Incidence increases with
age• May be associated with
low-fiber diet
• Clinically:• Most often
asymptomatic, diagnosed incidentally
• May be associated with lower abdominal discomfort, bloating, constipation
Diverticulitis
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Note wall thickening in the sigmoid colon (arrows) and adjacent inflammatory changes in the pericolic fat
• Demographics:• See Diverticulosis
• Clinically:• Abdominal pain, often
LLQ• Nausea• Vomiting• Constipation or diarrhea• Fever
Ulcerative Colitis
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• Demographics:• Peak incidence between
15 – 30 years old• Equal incidence in males
and females
• Clinically:• Diarrhea (can be > 10
loose stools / day), often bloody
• Rectal bleeding• Passage of mucus with
defecation• Abdominal pain• Constipation• Fever
Note diffuse thickening of the sigmoid colon (arrows) and minimal adjacent inflammatory stranding
Crohn’s Disease
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• Demographics:• Two peaks of incidence:
15 – 30 and 50 – 80 years old
• Equal incidence in males and females
• Clinically:• Abdominal pain• Diarrhea (usually non-
bloody)• Steatorrhea• Fatigue• Oral ulcers
Note thickening of the terminal ileum (curved arrow) and cecum (straight arrow) and inflammatory changes in the adjacent fat
Pseudomembranous colitis
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Note diffuse wall thickening throughout the colon (arrows), and pericolic inflammation
• Demographics:• Most commonly caused
by C.diff overgrowth following treatment with antibiotics
• Advanced age is risk factor
• Clinically:• Watery diarrhea (5-10x
per day)• Abdominal cramps• Hematochezia• Fever
Adenocarcinoma (Colon)• Demographics:
• Uncommon before age 40; 90% of cases are after age 50
• In the US, male incidence is 25% higher than female
• Clinically:• Abdominal pain• Change in bowel habits• Hematochezia or melena• Iron deficiency anemia
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Note circumferential thickening of the cecum (curved arrows) and a hypodense focus within the wall which is due to necrosis (straight arrow)
Quiz Cases
• Image presented first• Clinical history provided second• Diagnosis given last
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Case #1
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• 71 year old Male• LLQ abdominal
pain• Constipation• Nausea• Vomiting• Fever
Diagnosis: Diverticulitis Note diverticuli (arrows) and fascial thickening (arrowheads), indicating diverticulitis
Case #2
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• 17 year old Female• Frequent, bloody
diarrhea with mucus• Abdominal pain• Rectal bleeding• Fever
Diagnosis: Ulcerative colitisNote mucosal erosions (arrows) and normal luminal caliber and ascites (A)
Case #3
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• 55 year old Male• Abdominal pain• Thin, pencil-like
stools• Melena• Weight loss
Diagnosis: Adenocarcinoma of the colonNote erosion into the anterior abdominal wall (arrow)
Case #4• 61 year old
Female• Abdominal pain• Fever• 8 episodes of
diarrhea / day• Recently treated
for bacterial sinusitus
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Diagnosis: Pseudomembranous colitisNote diffuse colonic wall thickening, pericolic inflammation, and ascites. The thickened walls and small amount of contrast between folds has the appearance of an accordion (accordion sign)
Case #5
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• 73 year old Female
• No symptoms• Findings
incidentally noted on abdominal CT
Diagnosis: DiverticulosisNote diverticuli (arrows)
Case #6• 23 year old
Male • RLQ abdominal
pain• Nausea• Vomiting• Fever• Loss of appetite
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Diagnosis: Appendicitis
Note the dilated, fluid-filled appendix (arrows) and inflammatory changes in the adjacent fat
Case #7
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• 53 year old Female• Abdominal pain• Steatorrhea• Diarrhea• Fatigue
Diagnosis: Crohn’s DiseaseNote thickening of the terminal ileum and cecum (white arrows) along with fibrofatty proliferation (arrowheads). An enlarged lymph node is also visible (black arrow)
References• Horton KM, Corl FM, Fishman EK. CT Evaluation of the Colon: Inflammatory Disease. Radiographics,
March 2000 20:2 399-418• Horton KM, Abrams RA, Fishman EK. Spiral CT of Colon Cancer: Imaging Features and Role in
Management. Radiographics, 2000; 20:419–430• Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT Features of Ulcerative Colitis and Crohn’s
Disease. AJR, 1996; 167;3-15• Thoeni RF, Cello JP. CT Imaging of Colitis. Radiology, 2006; 240;623-638• http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/bowel_obstruction.htm• http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Surgery/Diveriticulitis1.htm• Demographic information and clinical signs/symptoms: www.uptodate.com