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Overview and CT Imaging Examples of Common Colon Pathologies Andy Nguyen Kellie Schenk.

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Presentation on theme: "Overview and CT Imaging Examples of Common Colon Pathologies Andy Nguyen Kellie Schenk."— Presentation transcript:

1 Overview and CT Imaging Examples of Common Colon Pathologies Andy Nguyen Kellie Schenk

2 Table of Contents Normal anatomy Appendicitis Diverticulosis Diverticulitis Ulcerative colitis Crohn’s disease Pseudomembranous colitis (C. diff)Pseudomembranous colitis (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

3 Normal Anatomy Return to Table of Contents CT Abdomen, Axial view

4 Appendicitis Return to Table of Contents Note enlargement of the appendix (arrows), intraluminal fluid, and adjacent inflammatory stranding Demographics: Any age, most commonly years old Slightly more common in males (1.4 : 1) Clinically : Abdominal pain, often RLQ Nausea Vomiting Fever

5 Appendicitis (cont’d) Compare to normal appendix Return to Table of Contents Normal air-filled appendix (arrow)

6 Diverticulosis Return to Table of Contents 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

7 Diverticulitis Return to Table of Contents Note wall thickening in the sigmoid colon (arrows) and adjacent inflammatory changes in the pericolic fat Demographics: See DiverticulosisDiverticulosis Clinically : Abdominal pain, often LLQ Nausea Vomiting Constipation or diarrhea Fever

8 Ulcerative Colitis Return to Table of Contents 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

9 Crohn’s Disease Return to Table of Contents 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

10 Pseudomembranous colitis Return to Table of Contents 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

11 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 Return to Table of Contents Note circumferential thickening of the cecum (curved arrows) and a hypodense focus within the wall which is due to necrosis (straight arrow)

12 Quiz Cases Image presented first Clinical history provided second Diagnosis given last Return to Table of Contents

13 Case #1 Return to Table of Contents 71 year old Male LLQ abdominal pain Constipation Nausea Vomiting Fever Diagnosis: Diverticulitis Note diverticuli (arrows) and fascial thickening (arrowheads), indicating diverticulitis

14 Case #2 Return to Table of Contents 17 year old Female Frequent, bloody diarrhea with mucus Abdominal pain Rectal bleeding Fever Diagnosis: Ulcerative colitis Note mucosal erosions (arrows) and normal luminal caliber and ascites (A)

15 Case #3 Return to Table of Contents 55 year old Male Abdominal pain Thin, pencil-like stools Melena Weight loss Diagnosis: Adenocarcinoma of the colon Note erosion into the anterior abdominal wall (arrow)

16 Case #4 61 year old Female Abdominal pain Fever 8 episodes of diarrhea / day Recently treated for bacterial sinusitus Return to Table of Contents Diagnosis: Pseudomembranous colitis Note 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)

17 Case #5 Return to Table of Contents 73 year old Female No symptoms Findings incidentally noted on abdominal CT Diagnosis: Diverticulosis Note diverticuli (arrows)

18 Case #6 23 year old Male RLQ abdominal pain Nausea Vomiting Fever Loss of appetite Return to Table of Contents Diagnosis: Appendicitis Note the dilated, fluid-filled appendix (arrows) and inflammatory changes in the adjacent fat

19 Case #7 Return to Table of Contents 53 year old Female Abdominal pain Steatorrhea Diarrhea Fatigue Diagnosis: Crohn’s Disease Note thickening of the terminal ileum and cecum (white arrows) along with fibrofatty proliferation (arrowheads). An enlarged lymph node is also visible (black arrow)

20 References Horton KM, Corl FM, Fishman EK. CT Evaluation of the Colon: Inflammatory Disease. Radiographics, March : 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; Demographic information and clinical signs/symptoms:


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