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US of Gastrointestinal Tract Abnormalities with CT Correlation¹

¹ From the Department of Medical Imaging, University Health Network and Mount Sinai Hospital at the University of Toronto, Toronto General Hospital, ES 1-401a, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. Recipient of a Certificate of Merit award for an education exhibit at the 2000 RSNA scientific assembly. Received April 12, 2002; revision requested May 14 and received June 19; accepted June 19. Address correspondence to M.E.O. (e-mail: martin.o’malley@uhn.on.ca).

View larger version (169K): [in a new window]   Figure 1a.  Appendicitis in a 25-year-old woman with right lower quadrant pain. (a) US image of the long axis of the appendix shows a noncompressible appendix with a diameter of 7 mm (between cursors). The patient had focal tenderness in this location. (b) Color Doppler US image of the short axis of the appendix shows hyperemia in the wall of the appendix. The US findings were diagnostic of acute appendicitis. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material before acquisition of the US images show that the appendix (arrow) measures 7 mm in diameter. The lumen is not filled with air or enteric contrast material. The wall is slightly thickened, but there is no inflammation of the periappendiceal fat. The CT findings were consistent with mild appendicitis, but the clinical condition of the patient was thought to be improving. The US study was therefore performed for further evaluation. Acute, nonperforated appendicitis was found at surgery.

View larger version (198K): [in a new window]   Figure 1b.  Appendicitis in a 25-year-old woman with right lower quadrant pain. (a) US image of the long axis of the appendix shows a noncompressible appendix with a diameter of 7 mm (between cursors). The patient had focal tenderness in this location. (b) Color Doppler US image of the short axis of the appendix shows hyperemia in the wall of the appendix. The US findings were diagnostic of acute appendicitis. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material before acquisition of the US images show that the appendix (arrow) measures 7 mm in diameter. The lumen is not filled with air or enteric contrast material. The wall is slightly thickened, but there is no inflammation of the periappendiceal fat. The CT findings were consistent with mild appendicitis, but the clinical condition of the patient was thought to be improving. The US study was therefore performed for further evaluation. Acute, nonperforated appendicitis was found at surgery.

View larger version (121K): [in a new window]   Figure 1c.  Appendicitis in a 25-year-old woman with right lower quadrant pain. (a) US image of the long axis of the appendix shows a noncompressible appendix with a diameter of 7 mm (between cursors). The patient had focal tenderness in this location. (b) Color Doppler US image of the short axis of the appendix shows hyperemia in the wall of the appendix. The US findings were diagnostic of acute appendicitis. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material before acquisition of the US images show that the appendix (arrow) measures 7 mm in diameter. The lumen is not filled with air or enteric contrast material. The wall is slightly thickened, but there is no inflammation of the periappendiceal fat. The CT findings were consistent with mild appendicitis, but the clinical condition of the patient was thought to be improving. The US study was therefore performed for further evaluation. Acute, nonperforated appendicitis was found at surgery.

View larger version (128K): [in a new window]   Figure 1d.  Appendicitis in a 25-year-old woman with right lower quadrant pain. (a) US image of the long axis of the appendix shows a noncompressible appendix with a diameter of 7 mm (between cursors). The patient had focal tenderness in this location. (b) Color Doppler US image of the short axis of the appendix shows hyperemia in the wall of the appendix. The US findings were diagnostic of acute appendicitis. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material before acquisition of the US images show that the appendix (arrow) measures 7 mm in diameter. The lumen is not filled with air or enteric contrast material. The wall is slightly thickened, but there is no inflammation of the periappendiceal fat. The CT findings were consistent with mild appendicitis, but the clinical condition of the patient was thought to be improving. The US study was therefore performed for further evaluation. Acute, nonperforated appendicitis was found at surgery.

View larger version (116K): [in a new window]   Figure 2a.  Acute Crohn disease involving the terminal ileum in a 25-year-old woman with right lower quadrant pain. (a) On a US image obtained through the long axis of the terminal ileum, it is thickened (arrow) with thick, echogenic submucosa related to lymphedema. A small phlegmonous collection (C) is present within the inflamed echogenic perienteric fat. (b) Axial CT scan shows thickening of the terminal ileum (arrow) and inflammation of the perienteric fat. (c) Axial CT scan obtained superior to b shows the phlegmon (arrow), which contains a tiny amount of air. (Fig 2a and 2b reprinted, with permission, from reference 17.)

View larger version (113K): [in a new window]   Figure 2b.  Acute Crohn disease involving the terminal ileum in a 25-year-old woman with right lower quadrant pain. (a) On a US image obtained through the long axis of the terminal ileum, it is thickened (arrow) with thick, echogenic submucosa related to lymphedema. A small phlegmonous collection (C) is present within the inflamed echogenic perienteric fat. (b) Axial CT scan shows thickening of the terminal ileum (arrow) and inflammation of the perienteric fat. (c) Axial CT scan obtained superior to b shows the phlegmon (arrow), which contains a tiny amount of air. (Fig 2a and 2b reprinted, with permission, from reference 17.)

View larger version (118K): [in a new window]   Figure 2c.  Acute Crohn disease involving the terminal ileum in a 25-year-old woman with right lower quadrant pain. (a) On a US image obtained through the long axis of the terminal ileum, it is thickened (arrow) with thick, echogenic submucosa related to lymphedema. A small phlegmonous collection (C) is present within the inflamed echogenic perienteric fat. (b) Axial CT scan shows thickening of the terminal ileum (arrow) and inflammation of the perienteric fat. (c) Axial CT scan obtained superior to b shows the phlegmon (arrow), which contains a tiny amount of air. (Fig 2a and 2b reprinted, with permission, from reference 17.)

View larger version (117K): [in a new window]   Figure 3a.  Diverticulitis in a 79-year-old woman with a history of diverticulitis and new onset of lower abdominal pain and urosepsis. (a) US image of the left lower quadrant obtained through the long axis of the sigmoid colon shows thickening of the muscular layer (arrows), which appears markedly hypoechoic. (b) Axial US image obtained through the sigmoid colon shows muscular hypertrophy (arrow) and an echogenic diverticulum (arrowhead). (c) Transvaginal US image shows a tract that contains air (arrowhead) and extends from the thickened sigmoid colon (arrow) to the bladder (B), which is filled with echogenic air and debris. (d) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows sigmoid diverticula (arrowheads) and air in the bladder (B), which confirm the diagnosis of a colovesical fistula secondary to diverticulitis.

View larger version (135K): [in a new window]   Figure 3b.  Diverticulitis in a 79-year-old woman with a history of diverticulitis and new onset of lower abdominal pain and urosepsis. (a) US image of the left lower quadrant obtained through the long axis of the sigmoid colon shows thickening of the muscular layer (arrows), which appears markedly hypoechoic. (b) Axial US image obtained through the sigmoid colon shows muscular hypertrophy (arrow) and an echogenic diverticulum (arrowhead). (c) Transvaginal US image shows a tract that contains air (arrowhead) and extends from the thickened sigmoid colon (arrow) to the bladder (B), which is filled with echogenic air and debris. (d) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows sigmoid diverticula (arrowheads) and air in the bladder (B), which confirm the diagnosis of a colovesical fistula secondary to diverticulitis.

View larger version (116K): [in a new window]   Figure 3c.  Diverticulitis in a 79-year-old woman with a history of diverticulitis and new onset of lower abdominal pain and urosepsis. (a) US image of the left lower quadrant obtained through the long axis of the sigmoid colon shows thickening of the muscular layer (arrows), which appears markedly hypoechoic. (b) Axial US image obtained through the sigmoid colon shows muscular hypertrophy (arrow) and an echogenic diverticulum (arrowhead). (c) Transvaginal US image shows a tract that contains air (arrowhead) and extends from the thickened sigmoid colon (arrow) to the bladder (B), which is filled with echogenic air and debris. (d) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows sigmoid diverticula (arrowheads) and air in the bladder (B), which confirm the diagnosis of a colovesical fistula secondary to diverticulitis.

View larger version (154K): [in a new window]   Figure 3d.  Diverticulitis in a 79-year-old woman with a history of diverticulitis and new onset of lower abdominal pain and urosepsis. (a) US image of the left lower quadrant obtained through the long axis of the sigmoid colon shows thickening of the muscular layer (arrows), which appears markedly hypoechoic. (b) Axial US image obtained through the sigmoid colon shows muscular hypertrophy (arrow) and an echogenic diverticulum (arrowhead). (c) Transvaginal US image shows a tract that contains air (arrowhead) and extends from the thickened sigmoid colon (arrow) to the bladder (B), which is filled with echogenic air and debris. (d) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows sigmoid diverticula (arrowheads) and air in the bladder (B), which confirm the diagnosis of a colovesical fistula secondary to diverticulitis.

View larger version (186K): [in a new window]   Figure 4a.  Right-sided diverticulitis in a 32-year-old woman with right lower quadrant pain and fever. (a) Axial US image obtained through the right lower quadrant shows a diverticulum (d) arising from the ascending colon (c) with surrounding inflamed echogenic fat (arrows), which indicate right-sided colonic diverticulitis. The patient had focal tenderness when the transducer was placed over this area. (b) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows the diverticulum, which arises from the ascending colon with inflammation of the surrounding fat (arrow). The appendix was normal.

View larger version (134K): [in a new window]   Figure 4b.  Right-sided diverticulitis in a 32-year-old woman with right lower quadrant pain and fever. (a) Axial US image obtained through the right lower quadrant shows a diverticulum (d) arising from the ascending colon (c) with surrounding inflamed echogenic fat (arrows), which indicate right-sided colonic diverticulitis. The patient had focal tenderness when the transducer was placed over this area. (b) Axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows the diverticulum, which arises from the ascending colon with inflammation of the surrounding fat (arrow). The appendix was normal.

View larger version (195K): [in a new window]   Figure 5a.  Epiploic appendagitis in a 29-year-old man with left lower quadrant pain. (a) Axial US image obtained over the point of maximum tenderness in the left lower quadrant shows an echogenic fingerlike epiploic appendage, which arises from the colon (C) and is surrounded by inflamed echogenic fat (arrow). (b) Corresponding axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows the epiploic appendage as a fingerlike structure of fat attenuation that arises from the colon with inflammation of the perienteric fat (arrow), findings diagnostic of epiploic appendagitis.

View larger version (93K): [in a new window]   Figure 5b.  Epiploic appendagitis in a 29-year-old man with left lower quadrant pain. (a) Axial US image obtained over the point of maximum tenderness in the left lower quadrant shows an echogenic fingerlike epiploic appendage, which arises from the colon (C) and is surrounded by inflamed echogenic fat (arrow). (b) Corresponding axial CT scan obtained after administration of oral, rectal, and intravenous contrast material shows the epiploic appendage as a fingerlike structure of fat attenuation that arises from the colon with inflammation of the perienteric fat (arrow), findings diagnostic of epiploic appendagitis.

View larger version (144K): [in a new window]   Figure 6a.  Pseudomembranous colitis in a 59-year-old woman with abdominal pain and diarrhea who was receiving intravenous antibiotics for urosepsis. (a, b) Axial (a) and longitudinal (b) US images obtained through the ascending colon (ac) and transverse colon (tc) show marked wall thickening and a prominent gyral pattern characteristic of pseudomembranous colitis. (c) Corresponding axial CT scan shows marked thickening of the ascending colon (ac) and transverse colon (tc). Stool cultures were positive for C difficile.

View larger version (132K): [in a new window]   Figure 6b.  Pseudomembranous colitis in a 59-year-old woman with abdominal pain and diarrhea who was receiving intravenous antibiotics for urosepsis. (a, b) Axial (a) and longitudinal (b) US images obtained through the ascending colon (ac) and transverse colon (tc) show marked wall thickening and a prominent gyral pattern characteristic of pseudomembranous colitis. (c) Corresponding axial CT scan shows marked thickening of the ascending colon (ac) and transverse colon (tc). Stool cultures were positive for C difficile.

View larger version (101K): [in a new window]   Figure 6c.  Pseudomembranous colitis in a 59-year-old woman with abdominal pain and diarrhea who was receiving intravenous antibiotics for urosepsis. (a, b) Axial (a) and longitudinal (b) US images obtained through the ascending colon (ac) and transverse colon (tc) show marked wall thickening and a prominent gyral pattern characteristic of pseudomembranous colitis. (c) Corresponding axial CT scan shows marked thickening of the ascending colon (ac) and transverse colon (tc). Stool cultures were positive for C difficile.

View larger version (131K): [in a new window]   Figure 7a.  Small bowel obstruction in a 51-year-old man with abdominal pain 10 days after liver transplantation. (a) Axial US image obtained through the lower abdomen shows thickened, dilated small bowel loops (arrows) within the abdominal cavity. A hernia sac (h) is identified anterior to the abdominal wall. (b) Axial US image obtained through the hernia sac shows septated ascites (h) and thickened, dilated small bowel loops (arrow). (c, d) Corresponding axial CT scans obtained with intravenous contrast material show identical findings of small bowel obstruction (arrows) secondary to an incisional hernia (h).

View larger version (109K): [in a new window]   Figure 7b.  Small bowel obstruction in a 51-year-old man with abdominal pain 10 days after liver transplantation. (a) Axial US image obtained through the lower abdomen shows thickened, dilated small bowel loops (arrows) within the abdominal cavity. A hernia sac (h) is identified anterior to the abdominal wall. (b) Axial US image obtained through the hernia sac shows septated ascites (h) and thickened, dilated small bowel loops (arrow). (c, d) Corresponding axial CT scans obtained with intravenous contrast material show identical findings of small bowel obstruction (arrows) secondary to an incisional hernia (h).

View larger version (100K): [in a new window]   Figure 7c.  Small bowel obstruction in a 51-year-old man with abdominal pain 10 days after liver transplantation. (a) Axial US image obtained through the lower abdomen shows thickened, dilated small bowel loops (arrows) within the abdominal cavity. A hernia sac (h) is identified anterior to the abdominal wall. (b) Axial US image obtained through the hernia sac shows septated ascites (h) and thickened, dilated small bowel loops (arrow). (c, d) Corresponding axial CT scans obtained with intravenous contrast material show identical findings of small bowel obstruction (arrows) secondary to an incisional hernia (h).

View larger version (91K): [in a new window]   Figure 7d.  Small bowel obstruction in a 51-year-old man with abdominal pain 10 days after liver transplantation. (a) Axial US image obtained through the lower abdomen shows thickened, dilated small bowel loops (arrows) within the abdominal cavity. A hernia sac (h) is identified anterior to the abdominal wall. (b) Axial US image obtained through the hernia sac shows septated ascites (h) and thickened, dilated small bowel loops (arrow). (c, d) Corresponding axial CT scans obtained with intravenous contrast material show identical findings of small bowel obstruction (arrows) secondary to an incisional hernia (h).

View larger version (153K): [in a new window]   Figure 8a.  Systemic lupus erythematosus in a 20-year-old woman with severe abdominal pain. (a, b) Longitudinal (a) and axial (b) US images show dilated small bowel loops (arrows) with markedly edematous mucosal folds. (c) Axial CT scan obtained with intravenous contrast material shows similar findings of thickened edematous mucosal folds (arrows). Mesenteric vasculitis was diagnosed, and the patient was treated with high-dose steroid therapy. Within 1 week, there was complete resolution of the symptoms and imaging findings. (Reprinted, with permission, from reference 17.)

View larger version (143K): [in a new window]   Figure 8b.  Systemic lupus erythematosus in a 20-year-old woman with severe abdominal pain. (a, b) Longitudinal (a) and axial (b) US images show dilated small bowel loops (arrows) with markedly edematous mucosal folds. (c) Axial CT scan obtained with intravenous contrast material shows similar findings of thickened edematous mucosal folds (arrows). Mesenteric vasculitis was diagnosed, and the patient was treated with high-dose steroid therapy. Within 1 week, there was complete resolution of the symptoms and imaging findings. (Reprinted, with permission, from reference 17.)

View larger version (120K): [in a new window]   Figure 8c.  Systemic lupus erythematosus in a 20-year-old woman with severe abdominal pain. (a, b) Longitudinal (a) and axial (b) US images show dilated small bowel loops (arrows) with markedly edematous mucosal folds. (c) Axial CT scan obtained with intravenous contrast material shows similar findings of thickened edematous mucosal folds (arrows). Mesenteric vasculitis was diagnosed, and the patient was treated with high-dose steroid therapy. Within 1 week, there was complete resolution of the symptoms and imaging findings. (Reprinted, with permission, from reference 17.)

View larger version (138K): [in a new window]   Figure 9a.  Celiac disease in a 35-year-old woman with diarrhea, weight loss, and anemia. (a) Axial US image shows dilated, fluid-filled small bowel loops with prominent mucosal folds (arrows). (b) Axial US image shows one of the multiple transient small bowel intussusceptions that were present. The echogenic mesenteric fat is seen trapped between the intussusceptum (i) and the intussuscipiens (o). (c, d) Corresponding axial CT scans obtained after administration of intravenous and oral contrast material show the dilated, fluid-filled small bowel loops (SB) as well as the intussusceptum (i) within the intussuscipiens (o) in the left lower quadrant. The suspected diagnosis of celiac disease, which was based on the imaging findings, was confirmed with biopsy of the small intestine, and the patient responded to a gluten-free diet. (Fig 9b reprinted, with permission, from reference 17.)

View larger version (158K): [in a new window]   Figure 9b.  Celiac disease in a 35-year-old woman with diarrhea, weight loss, and anemia. (a) Axial US image shows dilated, fluid-filled small bowel loops with prominent mucosal folds (arrows). (b) Axial US image shows one of the multiple transient small bowel intussusceptions that were present. The echogenic mesenteric fat is seen trapped between the intussusceptum (i) and the intussuscipiens (o). (c, d) Corresponding axial CT scans obtained after administration of intravenous and oral contrast material show the dilated, fluid-filled small bowel loops (SB) as well as the intussusceptum (i) within the intussuscipiens (o) in the left lower quadrant. The suspected diagnosis of celiac disease, which was based on the imaging findings, was confirmed with biopsy of the small intestine, and the patient responded to a gluten-free diet. (Fig 9b reprinted, with permission, from reference 17.)

View larger version (103K): [in a new window]   Figure 9c.  Celiac disease in a 35-year-old woman with diarrhea, weight loss, and anemia. (a) Axial US image shows dilated, fluid-filled small bowel loops with prominent mucosal folds (arrows). (b) Axial US image shows one of the multiple transient small bowel intussusceptions that were present. The echogenic mesenteric fat is seen trapped between the intussusceptum (i) and the intussuscipiens (o). (c, d) Corresponding axial CT scans obtained after administration of intravenous and oral contrast material show the dilated, fluid-filled small bowel loops (SB) as well as the intussusceptum (i) within the intussuscipiens (o) in the left lower quadrant. The suspected diagnosis of celiac disease, which was based on the imaging findings, was confirmed with biopsy of the small intestine, and the patient responded to a gluten-free diet. (Fig 9b reprinted, with permission, from reference 17.)

View larger version (107K): [in a new window]   Figure 9d.  Celiac disease in a 35-year-old woman with diarrhea, weight loss, and anemia. (a) Axial US image shows dilated, fluid-filled small bowel loops with prominent mucosal folds (arrows). (b) Axial US image shows one of the multiple transient small bowel intussusceptions that were present. The echogenic mesenteric fat is seen trapped between the intussusceptum (i) and the intussuscipiens (o). (c, d) Corresponding axial CT scans obtained after administration of intravenous and oral contrast material show the dilated, fluid-filled small bowel loops (SB) as well as the intussusceptum (i) within the intussuscipiens (o) in the left lower quadrant. The suspected diagnosis of celiac disease, which was based on the imaging findings, was confirmed with biopsy of the small intestine, and the patient responded to a gluten-free diet. (Fig 9b reprinted, with permission, from reference 17.)

View larger version (135K): [in a new window]   Figure 10a.  Gastric cancer in a 68-year-old man with early satiety and anemia. (a) US image obtained through the long axis of the stomach shows a large hypoechoic tumor (arrows) that replaces the gastric wall; echogenic air in the lumen creates a pseudokidney appearance. (b) Axial CT scan obtained with intravenous contrast material shows that the tumor (arrows) involves the distal stomach. The pathologic diagnosis was poorly differentiated gastric adenocarcinoma.

View larger version (111K): [in a new window]   Figure 10b.  Gastric cancer in a 68-year-old man with early satiety and anemia. (a) US image obtained through the long axis of the stomach shows a large hypoechoic tumor (arrows) that replaces the gastric wall; echogenic air in the lumen creates a pseudokidney appearance. (b) Axial CT scan obtained with intravenous contrast material shows that the tumor (arrows) involves the distal stomach. The pathologic diagnosis was poorly differentiated gastric adenocarcinoma.

View larger version (131K): [in a new window]   Figure 11a.  Known non-Hodgkin lymphoma involving the small intestine in a 51-year-old man. (a, b) US images obtained through the long axis (a) and short axis (b) of the small intestine in the right upper quadrant show asymmetric thickening of the bowel wall (arrow) and aneurysmal dilatation of the lumen (L). There is lymphadenopathy (arrowhead) in the adjacent mesentery. (c) Axial CT scan obtained with oral and intravenous contrast material shows that the tumor (arrow) involves the small intestine with aneurysmal dilatation of the lumen (L) and lymphadenopathy (arrowhead).

View larger version (129K): [in a new window]   Figure 11b.  Known non-Hodgkin lymphoma involving the small intestine in a 51-year-old man. (a, b) US images obtained through the long axis (a) and short axis (b) of the small intestine in the right upper quadrant show asymmetric thickening of the bowel wall (arrow) and aneurysmal dilatation of the lumen (L). There is lymphadenopathy (arrowhead) in the adjacent mesentery. (c) Axial CT scan obtained with oral and intravenous contrast material shows that the tumor (arrow) involves the small intestine with aneurysmal dilatation of the lumen (L) and lymphadenopathy (arrowhead).

View larger version (144K): [in a new window]   Figure 11c.  Known non-Hodgkin lymphoma involving the small intestine in a 51-year-old man. (a, b) US images obtained through the long axis (a) and short axis (b) of the small intestine in the right upper quadrant show asymmetric thickening of the bowel wall (arrow) and aneurysmal dilatation of the lumen (L). There is lymphadenopathy (arrowhead) in the adjacent mesentery. (c) Axial CT scan obtained with oral and intravenous contrast material shows that the tumor (arrow) involves the small intestine with aneurysmal dilatation of the lumen (L) and lymphadenopathy (arrowhead).

View larger version (128K): [in a new window]   Figure 12a.  Colon cancer in a 69-year-old woman with abdominal pain and a sensation of "fullness" in the right lower quadrant. (a) Axial US image obtained through the right side of the abdomen shows a markedly dilated transverse colon (tc) filled with liquid stool. (b) Midline axial US image shows an annular, hypoechoic mass (arrowheads) that produces an abrupt zone of transition in the transverse colon (tc), an appearance consistent with obstructing colon cancer. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material show obstruction of the transverse colon (tc) secondary to a tight, annular adenocarcinoma of the colon (arrowhead), which was confirmed at surgery.

View larger version (118K): [in a new window]   Figure 12b.  Colon cancer in a 69-year-old woman with abdominal pain and a sensation of "fullness" in the right lower quadrant. (a) Axial US image obtained through the right side of the abdomen shows a markedly dilated transverse colon (tc) filled with liquid stool. (b) Midline axial US image shows an annular, hypoechoic mass (arrowheads) that produces an abrupt zone of transition in the transverse colon (tc), an appearance consistent with obstructing colon cancer. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material show obstruction of the transverse colon (tc) secondary to a tight, annular adenocarcinoma of the colon (arrowhead), which was confirmed at surgery.

View larger version (124K): [in a new window]   Figure 12c.  Colon cancer in a 69-year-old woman with abdominal pain and a sensation of "fullness" in the right lower quadrant. (a) Axial US image obtained through the right side of the abdomen shows a markedly dilated transverse colon (tc) filled with liquid stool. (b) Midline axial US image shows an annular, hypoechoic mass (arrowheads) that produces an abrupt zone of transition in the transverse colon (tc), an appearance consistent with obstructing colon cancer. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material show obstruction of the transverse colon (tc) secondary to a tight, annular adenocarcinoma of the colon (arrowhead), which was confirmed at surgery.

View larger version (112K): [in a new window]   Figure 12d.  Colon cancer in a 69-year-old woman with abdominal pain and a sensation of "fullness" in the right lower quadrant. (a) Axial US image obtained through the right side of the abdomen shows a markedly dilated transverse colon (tc) filled with liquid stool. (b) Midline axial US image shows an annular, hypoechoic mass (arrowheads) that produces an abrupt zone of transition in the transverse colon (tc), an appearance consistent with obstructing colon cancer. (c, d) Corresponding axial CT scans obtained with oral, rectal, and intravenous contrast material show obstruction of the transverse colon (tc) secondary to a tight, annular adenocarcinoma of the colon (arrowhead), which was confirmed at surgery.

View larger version (157K): [in a new window]   Figure 13a.  Colon cancer in an 80-year-old man with foul-smelling urine and gross hematuria. (a, b) Sagittal (a) and axial (b) US images obtained through the pelvis show a large, hypoechoic mass of the sigmoid colon (arrow) adjacent to the dome of the bladder (B). Air (arrowheads) is seen along a fistulous tract from the mass to the nondependent portion of the bladder. During real-time US, bubbles of air were seen moving along the fistula. (c, d) Corresponding axial CT scans show that the mass (arrow) invades the bladder (B). There is air within the bladder, a finding indicative of a colovesical fistula. An adenocarcinoma of the sigmoid colon with a colovesical fistula was confirmed at surgery.

View larger version (145K): [in a new window]   Figure 13b.  Colon cancer in an 80-year-old man with foul-smelling urine and gross hematuria. (a, b) Sagittal (a) and axial (b) US images obtained through the pelvis show a large, hypoechoic mass of the sigmoid colon (arrow) adjacent to the dome of the bladder (B). Air (arrowheads) is seen along a fistulous tract from the mass to the nondependent portion of the bladder. During real-time US, bubbles of air were seen moving along the fistula. (c, d) Corresponding axial CT scans show that the mass (arrow) invades the bladder (B). There is air within the bladder, a finding indicative of a colovesical fistula. An adenocarcinoma of the sigmoid colon with a colovesical fistula was confirmed at surgery.

View larger version (111K): [in a new window]   Figure 13c.  Colon cancer in an 80-year-old man with foul-smelling urine and gross hematuria. (a, b) Sagittal (a) and axial (b) US images obtained through the pelvis show a large, hypoechoic mass of the sigmoid colon (arrow) adjacent to the dome of the bladder (B). Air (arrowheads) is seen along a fistulous tract from the mass to the nondependent portion of the bladder. During real-time US, bubbles of air were seen moving along the fistula. (c, d) Corresponding axial CT scans show that the mass (arrow) invades the bladder (B). There is air within the bladder, a finding indicative of a colovesical fistula. An adenocarcinoma of the sigmoid colon with a colovesical fistula was confirmed at surgery.

View larger version (118K): [in a new window]   Figure 13d.  Colon cancer in an 80-year-old man with foul-smelling urine and gross hematuria. (a, b) Sagittal (a) and axial (b) US images obtained through the pelvis show a large, hypoechoic mass of the sigmoid colon (arrow) adjacent to the dome of the bladder (B). Air (arrowheads) is seen along a fistulous tract from the mass to the nondependent portion of the bladder. During real-time US, bubbles of air were seen moving along the fistula. (c, d) Corresponding axial CT scans show that the mass (arrow) invades the bladder (B). There is air within the bladder, a finding indicative of a colovesical fistula. An adenocarcinoma of the sigmoid colon with a colovesical fistula was confirmed at surgery.