HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Horton, K. M. Articles by Fishman, E. K. Search for Related Content PubMed PubMed Citation Articles by Horton, K. M. Articles by Fishman, E. K. Related Collections Computed Tomography Gastrointestinal Radiology Related Article

CT Evaluation of the Colon: Inflammatory Disease¹

¹ From the Department of Radiology, Johns Hopkins Medical Institutions, 601 N Caroline St, Baltimore, MD 21287. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 26, 1999; revision requested March 29 and received May 14; accepted May 17. Address reprint requests to E.K.F. (e-mail: efishman@jhmi.edu).

View larger version (95K): [in a new window]   Figure 1.   Normal colon. Drawing shows the structures of the colon, including the teniae, haustra, and appendices epiploicae.

View larger version (68K): [in a new window]   Figure 2.   Colonic interposition. Drawing shows the colon interposed between the liver and the diaphragm.

View larger version (176K): [in a new window]   Figure 3.   Colon in empty renal fossa in a 55-year-old man who underwent nephrectomy for renal cell carcinoma. Contrast material-enhanced spiral CT scan shows the colon (C) and spleen (S) located in the left renal fossa.

View larger version (39K): [in a new window]   Figure 4.   Appendicolith. Drawing shows an appendicolith that obstructs the appendiceal lumen, resulting in dilatation of the appendix and wall thickening.

View larger version (154K): [in a new window]   Figure 5.   Normal appendix. Contrast-enhanced spiral CT scan shows a normal air-filled appendix (arrow).

View larger version (146K): [in a new window]   Figure 6.   Appendicitis. Contrast-enhanced spiral CT scan shows a dilated, fluid-filled appendix (arrows). Minimal inflammatory changes are also present in the adjacent mesenteric fat.

View larger version (143K): [in a new window]   Figure 7.   Appendicitis in a patient with acute-onset right lower quadrant pain. Spiral CT scan obtained with oral and intravenous contrast material shows enlargement of the appendix, which is filled with fluid (arrows). Adjacent inflammatory stranding is also present. Intravenous contrast material can help define the thickened walls of the appendix.

View larger version (161K): [in a new window]   Figure 8.   Appendicitis in a patient with acute-onset right lower quadrant pain. Nonenhanced CT scan shows moderate inflammatory changes in the right lower quadrant. An appendicolith is identified (arrow).

View larger version (150K): [in a new window]   Figure 9.   Periappendiceal abscess in an 80-year-old woman with right lower quadrant pain and fever. Contrast-enhanced CT scan shows an inflammatory mass with an air-fluid level in the right lower quadrant (arrow) and associated inflammatory changes in the pericecal fat. A periappendiceal abscess was discovered at surgery.

View larger version (146K): [in a new window]   Figure 10.   Epiploic appendagitis in a 16-year-old girl with severe left lower quadrant pain. Contrast-enhanced spiral CT scan shows a 2.5-cm-diameter mass (straight arrow) with fat attenuation and mesenteric stranding. The mass is adjacent to the descending colon (curved arrow) and was thought to represent inflammation of the appendix epiploica on the basis of the CT findings. The patient was treated conservatively, and the pain resolved within 24 hours.

View larger version (64K): [in a new window]   Figure 11.   Diverticulosis. Drawing shows colonic diverticulosis and circular muscle hypertrophy.

View larger version (163K): [in a new window]   Figure 12.   Diverticulosis. Spiral CT scan obtained with oral and intravenous contrast material shows moderate diverticulosis of the sigmoid colon.

View larger version (155K): [in a new window]   Figure 13.   Diverticulitis. CT scan obtained with oral and intravenous contrast material shows wall thickening in the sigmoid colon (arrows) with adjacent inflammatory changes in the pericolic fat.

View larger version (154K): [in a new window]   Figure 14.   Diverticular abscess. CT scan obtained with oral and intravenous contrast material shows moderate wall thickening in the sigmoid colon (S) with significant adjacent inflammatory changes and stranding of the pericolic fat. A 3-cm-diameter fluid collection (*) is seen between the sigmoid colon and bladder (B), a finding compatible with a diverticular abscess.

View larger version (161K): [in a new window]   Figure 15.   Colovesical fistula. CT scan obtained with oral and intravenous contrast material shows moderate wall thickening in the sigmoid colon (S) with adjacent inflammatory changes and stranding of the pericolic fat. Focal wall thickening is seen in the left posterior part of the bladder adjacent to the inflamed sigmoid (arrow). A moderate amount of air is also present in the bladder, a finding compatible with a colovesical fistula. Small collections of retained barium are identified within diverticula.

View larger version (134K): [in a new window]   Figure 16a.   Diverticulitis. CT scans obtained with oral contrast material show focal thickening of the sigmoid colon (straight arrow) with adjacent inflammatory changes in the pericolic fat. This appearance can be difficult to distinguish from that of colorectal cancer. However, the presence of mesenteric fluid (curved arrow in a) favors diverticulitis.

View larger version (140K): [in a new window]   Figure 16b.   Diverticulitis. CT scans obtained with oral contrast material show focal thickening of the sigmoid colon (straight arrow) with adjacent inflammatory changes in the pericolic fat. This appearance can be difficult to distinguish from that of colorectal cancer. However, the presence of mesenteric fluid (curved arrow in a) favors diverticulitis.

View larger version (75K): [in a new window]   Figure 17.   Typhlitis. Drawing shows the significant wall thickening that involves the cecum in patients with typhlitis.

View larger version (151K): [in a new window]   Figure 18.   Typhlitis in a patient with acute myelogenous leukemia. Nonenhanced CT scan shows inflammation and marked thickening of the cecum (arrowheads), findings compatible with typhlitis. Minimal pericecal inflammation is present in the adjacent mesenteric fat. The descending colon (D) appears normal.

View larger version (71K): [in a new window]   Figure 19.   Radiation fibrosis. Drawing shows smooth wall thickening and fibrosis in the sigmoid colon, which narrow the colonic lumen.

View larger version (149K): [in a new window]   Figure 20.   Radiation proctitis in a 38-year-old woman who underwent radiation therapy for cervical cancer. CT scan of the pelvis shows marked thickening of the cervix and vagina (curved arrow) with necrosis (open arrow), findings compatible with known locally invasive cervical cancer. Marked thickening of the rectum due to radiation colitis is also present (solid straight arrows).

View larger version (146K): [in a new window]   Figure 21.   Crohn disease. CT scan obtained with oral contrast material shows moderate thickening of the terminal ileum (curved arrow) and cecum (straight arrow) with adjacent inflammatory changes in the pericolic fat.

View larger version (159K): [in a new window]   Figure 22.   Ulcerative colitis in a 27-year-old man. Contrast-enhanced CT scan shows minimal diffuse thickening of the sigmoid colon with minimal inflammatory stranding. The remainder of the colon was normal (not shown).

View larger version (78K): [in a new window]   Figure 23.   Crohn disease. Drawing shows submucosal fat in the cecum and terminal ileum.

View larger version (141K): [in a new window]   Figure 24.   Crohn disease. CT scan obtained with oral contrast material shows low-attenuation submucosal fat in the ascending colon (arrow) and fibrofatty proliferation of adjacent mesenteric fat (*).

View larger version (151K): [in a new window]   Figure 25.   Ulcerative colitis. CT scan of a patient with long-standing ulcerative colitis shows a submucosal halo of fat within the rectum (arrow). There is also perirectal fibrofatty proliferation (*).

View larger version (133K): [in a new window]   Figure 26.   Crohn disease. CT scan obtained with oral and intravenous contrast material shows an abscess involving the iliacus muscle (black arrow) with a fistula to the anterior abdominal wall (white arrow).

View larger version (142K): [in a new window]   Figure 27.   Diffuse ischemic colitis. CT scan obtained with oral and intravenous contrast material shows diffuse, low-attenuation thickening of the colonic wall (arrows). This is an example of the halo sign.

View larger version (151K): [in a new window]   Figure 28.   Segmental ischemic colitis. CT scan obtained with oral and intravenous contrast material shows focal thickening of two colonic loops in the left abdomen (arrows).

View larger version (142K): [in a new window]   Figure 29a.   Ischemic colitis in a 65-year-old man with abdominal pain after surgery for pancreatic cancer. Contrast-enhanced spiral CT scans show marked edema and thickening of the small bowel (SB) and colon (C) to the level of the splenic flexure, findings compatible with ischemia due to thrombus in the superior mesenteric vein (arrow in a). There is also moderate atherosclerosis of the aorta and ascites.

View larger version (136K): [in a new window]   Figure 29b.   Ischemic colitis in a 65-year-old man with abdominal pain after surgery for pancreatic cancer. Contrast-enhanced spiral CT scans show marked edema and thickening of the small bowel (SB) and colon (C) to the level of the splenic flexure, findings compatible with ischemia due to thrombus in the superior mesenteric vein (arrow in a). There is also moderate atherosclerosis of the aorta and ascites.

View larger version (59K): [in a new window]   Figure 30.   Ischemic colitis. Drawing shows ischemia and pneumatosis involving a segment of colon.

View larger version (133K): [in a new window]   Figure 31.   Ischemic colitis in a critically ill patient. CT scan obtained with oral and intravenous contrast material shows pneumatosis involving the ascending colon and transverse colon (arrows), findings compatible with ischemia and infarction.

View larger version (165K): [in a new window]   Figure 32a.   Graft-versus-host disease in a 35-year-old man after bone marrow transplantation. Contrast-enhanced spiral CT scans show diffuse thickening and edema of the small intestine (a) and colon (b). There is also mesenteric stranding and edema, which are compatible with inflammation.

View larger version (155K): [in a new window]   Figure 32b.   Graft-versus-host disease in a 35-year-old man after bone marrow transplantation. Contrast-enhanced spiral CT scans show diffuse thickening and edema of the small intestine (a) and colon (b). There is also mesenteric stranding and edema, which are compatible with inflammation.

View larger version (60K): [in a new window]   Figure 33.   Graft-versus-host disease. Drawing shows incorporation of oral barium into the submucosal layer of the bowel wall.

View larger version (158K): [in a new window]   Figure 34.   Graft-versus-host disease. Nonenhanced CT scan shows barium within the colonic wall (arrows) from a previous contrast enema examination performed 6 weeks earlier.

View larger version (159K): [in a new window]   Figure 35.   Infectious colitis from Escherichia coli in a 52-year-old man with abdominal pain and severe bloody diarrhea. CT scan obtained with oral and intravenous contrast material shows moderate thickening of the colon (arrows) and inflammatory changes in the mesenteric fat. E coli was cultured from stool.

View larger version (79K): [in a new window]   Figure 36.   Pseudomembranous colitis. Drawing shows marked colonic wall thickening and mucosal plaques.

View larger version (156K): [in a new window]   Figure 37.   Pseudomembranous colitis. Spiral CT scan obtained with oral and intravenous contrast material shows marked wall thickening throughout the colon (thickness, 15 mm) and pericolic inflammation. The thickening in the transverse colon is asymmetric.

View larger version (176K): [in a new window]   Figure 38.   Pseudomembranous colitis. Spiral CT scan obtained with oral and intravenous contrast material shows marked wall thickening throughout the colon. The wall is of low attenuation, which is compatible with edema or inflammation, and there is significant enhancement of the mucosa due to hyperemia. There is also moderate pericolic inflammation and ascites.

View larger version (173K): [in a new window]   Figure 39.   Accordion sign in a patient with pseudomembranous colitis. Spiral CT scan obtained with oral contrast material shows marked wall thickening throughout the colon. The colonic wall is so thick that only minimal contrast material can be seen sandwiched between the thick walls, creating the appearance of an accordion. There is also pericolic inflammation and ascites.

View larger version (150K): [in a new window]   Figure 40.   Pseudomembranous colitis in a patient with severe diarrhea. Spiral CT scan obtained with oral contrast material shows rectal thickening (arrows) and perirectal inflammation. The remainder of the colon was normal (not shown). Pseudomembranous colitis was diagnosed at endoscopy.