DOI: 10.1148/rg.265045191
Multi–Detector Row CT: Spectrum of Diseases Involving the Ileocecal Area1
Christine Hoeffel, MD,
Michel D. Crema, MD,
Ahcène Belkacem, MD,
Louisa Azizi, MD,
Maité Lewin, MD, PhD,
Lionel Arrivé, MD and
Jean-Michel Tubiana, MD
1 From the Department of Radiology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571 Paris Cedex 12, France (C.H., M.D.C., A.B., L. Azizi, M.L., L. Arrivé, J.M.T.); and the Department of Medicine, Université Paris-Descartes, Paris, France (C.H.). Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received October 26, 2004; revision requested January 5, 2005; final revision received July 1; accepted July 26. All authors have no financial relationships to disclose.
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Figure 1. Mucinous colic adenocarcinoma in a 49-year-old man. Coronal oblique reformatted multi–detector row CT image shows a bulky, irregular heterogeneous mass (arrows) involving both the cecum and the terminal ileum with abrupt transition on the right colon, mild fat stranding (arrowheads), and small mesenteric lymph nodes.
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Figure 2. Adenocarcinoma of the terminal ileum in a 56-year-old woman with Crohn disease who presented with a sudden occlusive syndrome. Intestinoscopy revealed a stenosis that could not be bypassed with an endoscope. Oblique sagittal reformatted multi–detector row CT image obtained through the ileocecal junction shows obstructive stenosis of the terminal ileum (arrow). Resection of the terminal ileum revealed a small bowel adenocarcinoma 2 cm from the ileocecal valve.
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Figure 3a. Carcinoid tumor of the terminal ileum in a 47-year-old man. Coronal oblique reformatted multi–detector row CT images show an ill-defined, spiculated mesenteric mass (arrows in a) and a small enhancing nodule of the terminal ileal wall (arrows in b). Note also the hepatic metastases.
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Figure 3b. Carcinoid tumor of the terminal ileum in a 47-year-old man. Coronal oblique reformatted multi–detector row CT images show an ill-defined, spiculated mesenteric mass (arrows in a) and a small enhancing nodule of the terminal ileal wall (arrows in b). Note also the hepatic metastases.
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Figure 4a. Appendiceal carcinoid tumor in a 60-year-old woman who presented with right lower quadrant pain. (a) Multi–detector row CT scan shows a mildly enlarged (8-mm) appendix (arrow) with surrounding fat stranding (arrowhead). (b) Coronal oblique reformatted multi–detector row CT image shows associated thickening of the cecum (arrow) and terminal ileum (arrowhead). Surgery and pathologic examination revealed a carcinoid tumor of the appendix.
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Figure 4b. Appendiceal carcinoid tumor in a 60-year-old woman who presented with right lower quadrant pain. (a) Multi–detector row CT scan shows a mildly enlarged (8-mm) appendix (arrow) with surrounding fat stranding (arrowhead). (b) Coronal oblique reformatted multi–detector row CT image shows associated thickening of the cecum (arrow) and terminal ileum (arrowhead). Surgery and pathologic examination revealed a carcinoid tumor of the appendix.
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Figure 5. Non-Hodgkin ileocecal lymphoma in a 55-year-old man. Multi–detector row CT scan shows marked homogeneous symmetric thickening of the cecal wall. There is no stenosis of the lumen (arrowhead). Large regional and mesenteric lymphadenopathies (arrows) are also seen. Note the presence of fat stranding, which is, however, less severe than the wall thickening.
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Figure 6. Cecal metastasis from hepatocellular carcinoma in a 60-year-old man. Multi–detector row CT scan shows a large, hyperattenuating subserosal cecal mass (arrows).
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Figure 7. Lipoma of the ileocecal valve in a 70-year-old man. Sagittal oblique reformatted multi–detector row CT image shows a lipoma located at the level of the ileocecal junction, appearing as a well-defined small fatty mass (arrow).
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Figure 8. Lipomatosis of the ileocecal valve in a 40-year-old man. Sagittal oblique reformatted multi–detector row CT image of the ileocecal junction shows symmetric fatty enlargement of the ileocecal valve (arrows).
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Figure 9. Incidentally discovered mucocele (mucinous appendiceal adenoma) in a 71-year-old man. Coronal oblique reformatted multi–detector row CT image tilted laterally shows the full extent of an elongated cystic mass (arrowheads) and its proximity to the base of the cecum (arrow).
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Figure 10. Adenocarcinoma of the ileocecal valve in a 92-year-old patient. CT scan through the ileocecal junction shows an enhancing mass (arrow) causing small bowel obstruction. Note the presence of the "small bowel feces sign" in the small bowel loops. Surgery helped confirm adenocarcinoma of the ileocecal valve.
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Figure 11. Terminal ileal lipoma. CT scan shows a rounded, well-limited mass with fat attenuation (arrow) at the leading end of an ileocolic intussusception. Surgery helped confirm terminal ileal lipoma as the cause of the intussusception.
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Figure 12. Enteric duplication cyst in a 35-year-old patient who presented with acute abdominal pain. The patient had recently undergone colonoscopy, which had revealed a submucosal mass resembling a terminal ileal lipoma protruding into the ileocecal valve. Coronal oblique reformatted multi–detector row CT image through the leading end of an ileocecal intussusception shows a nonenhancing, homogeneous soft-tissue mass (arrow). Laparoscopic ileocecal resection revealed a large (3.5-cm) duplication cyst at the ileocecal junction.
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Figure 13a. Cecal adenocarcinoma. (a) Multi–detector row CT scan shows a cecocolic intussusception. Mesenteric fat and contrast material–enhanced mesenteric vessels are seen within the lumen of the intussusception (arrow). (b) Coronal oblique reformatted multi–detector row CT image through the leading end of the intussuscipiens shows an enhancing mass (arrow), which proved to be cecal adenocarcinoma.
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Figure 13b. Cecal adenocarcinoma. (a) Multi–detector row CT scan shows a cecocolic intussusception. Mesenteric fat and contrast material–enhanced mesenteric vessels are seen within the lumen of the intussusception (arrow). (b) Coronal oblique reformatted multi–detector row CT image through the leading end of the intussuscipiens shows an enhancing mass (arrow), which proved to be cecal adenocarcinoma.
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Figure 14. Inverted Meckel diverticulum with an ileoileal intussusception. Contrast-enhanced CT scan demonstrates an ileoileal intussusception, which appears as a central focus of fat attenuation with concentric rings of alternating fat and soft-tissue attenuation (arrow). These findings represent a core of mesenteric fat surrounded by the wall of the diverticulum and the intestinal wall.
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Figure 15a. Appendicitis in a 30-year-old patient. (a) Sagittal oblique reformatted multi–detector row CT image shows the full length of an inflamed appendix (arrowhead) and mild thickening of the cecal base (arrow). (b) Coronal oblique reformatted multi–detector row CT image shows thickening of both the terminal ileum (arrowhead) and the cecal base (arrow).
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Figure 15b. Appendicitis in a 30-year-old patient. (a) Sagittal oblique reformatted multi–detector row CT image shows the full length of an inflamed appendix (arrowhead) and mild thickening of the cecal base (arrow). (b) Coronal oblique reformatted multi–detector row CT image shows thickening of both the terminal ileum (arrowhead) and the cecal base (arrow).
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Figure 16. Perforated appendicitis in a 40-year-old man. Coronal oblique reformatted multi–detector row CT image shows severe fat stranding of the ileocecal area, along with thickening of the cecal base and terminal ileum. The appendix is not identified. Note the presence of secondary epiploic appendagitis of the cecum, which appears as an oval, paracecal fatty mass with a well-circumscribed, hyperattenuating rim (arrows).
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Figure 17a. Right colic diverticulitis in a 36-year-old man with hyperleukocytosis who presented with acute right lower quadrant pain. The patient had undergone appendectomy 8 years earlier. Coronal oblique reformatted multi–detector row CT images show mild thickening of the cecal wall; an inflamed enhancing diverticulum with a thickened wall (arrow in a); stranding of peridiverticular and pericecal fat; and a thickened terminal ileum (arrow in b). These findings led to a diagnosis of right colic diverticulitis.
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Figure 17b. Right colic diverticulitis in a 36-year-old man with hyperleukocytosis who presented with acute right lower quadrant pain. The patient had undergone appendectomy 8 years earlier. Coronal oblique reformatted multi–detector row CT images show mild thickening of the cecal wall; an inflamed enhancing diverticulum with a thickened wall (arrow in a); stranding of peridiverticular and pericecal fat; and a thickened terminal ileum (arrow in b). These findings led to a diagnosis of right colic diverticulitis.
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Figure 18a. Cecal diverticulitis in a 23-year-old woman who presented with left upper quadrant pain and an elevated C-reactive protein level. The patient had undergone appendectomy in 1980. (a) Oblique reformatted multi–detector row CT image shows a thickened, hypoattenuating diverticular wall with preservation of a layered enhancement pattern (arrow), as well as diverticular inflammation (arrowhead). (b) Coronal oblique reformatted multi–detector row CT image helps confirm marked symmetric thickening of the cecal wall (arrowhead) and terminal ileum (arrows). Laparoscopic surgery was performed for persistent abdominal pain and helped confirm cecal diverticulitis.
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Figure 18b. Cecal diverticulitis in a 23-year-old woman who presented with left upper quadrant pain and an elevated C-reactive protein level. The patient had undergone appendectomy in 1980. (a) Oblique reformatted multi–detector row CT image shows a thickened, hypoattenuating diverticular wall with preservation of a layered enhancement pattern (arrow), as well as diverticular inflammation (arrowhead). (b) Coronal oblique reformatted multi–detector row CT image helps confirm marked symmetric thickening of the cecal wall (arrowhead) and terminal ileum (arrows). Laparoscopic surgery was performed for persistent abdominal pain and helped confirm cecal diverticulitis.
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Figure 19. Terminal ileal diverticulitis in a 55-year-old man. Multi–detector row CT scan shows inflamed diverticula on the terminal ileum with surrounding fat stranding (arrows).
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Figure 20. Epiploic appendagitis in a young male patient with acute right iliac fossa pain. Multi–detector row CT scan demonstrates an oval, paracecal fatty mass (arrows) with surrounding fat stranding.
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Figure 21a. Crohn disease in a 41-year-old man. (a) Multi–detector row CT scan shows an enlarged appendix (black arrow), stratified symmetric thickening of the terminal ileum (arrowheads), and adjacent creeping fat (white arrow). (b) Sagittal reformatted multi–detector row CT image demonstrates hypoattenuating symmetric thickening of the cecal wall (arrowheads) and stratified thickening of the terminal ileum (arrows).
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Figure 21b. Crohn disease in a 41-year-old man. (a) Multi–detector row CT scan shows an enlarged appendix (black arrow), stratified symmetric thickening of the terminal ileum (arrowheads), and adjacent creeping fat (white arrow). (b) Sagittal reformatted multi–detector row CT image demonstrates hypoattenuating symmetric thickening of the cecal wall (arrowheads) and stratified thickening of the terminal ileum (arrows).
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Figure 22. Crohn disease in a 33-year-old man. Sagittal oblique reformatted multi–detector row CT image shows a thickened, inflammatory terminal ileum (arrowheads) with a fistula and retroperitoneal abscess posteriorly (arrows).
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Figure 23. Terminal ileitis due to Campylobacter infection in a 28-year-old patient. Multi–detector row CT scan shows marked thickening of the cecum (arrowheads) and terminal ileum (arrows) with preservation of a layered enhancement pattern. Note the small regional lymph nodes and the absence of fat stranding.
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Figure 24a. Terminal ileitis in a 51-year-old woman who presented with acute abdominal pain and fever. A mass was palpated in the right iliac fossa. (a) Multi–detector row CT scan shows marked right colic wall thickening with preservation of a layered enhancement pattern (arrowhead), a finding that helped rule out lym-phoma. A cluster of lymphadenopathies (arrows) is also seen. (b) Multi–detector row CT scan shows thickening of the terminal ileum (arrowhead). Arrows indicate the cluster of lymphadenopathies. Laparoscopy was performed owing to these CT findings and helped confirm infectious disease due to Y enterocolitica.
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Figure 24b. Terminal ileitis in a 51-year-old woman who presented with acute abdominal pain and fever. A mass was palpated in the right iliac fossa. (a) Multi–detector row CT scan shows marked right colic wall thickening with preservation of a layered enhancement pattern (arrowhead), a finding that helped rule out lymphoma. A cluster of lymphadenopathies (arrows) is also seen. (b) Multi–detector row CT scan shows thickening of the terminal ileum (arrowhead). Arrows indicate the cluster of lymphadenopathies. Laparoscopy was performed owing to these CT findings and helped confirm infectious disease due to Y enterocolitica.
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Figure 25a. Tubo-ovarian abscess with mild inflammatory reactive changes of the cecal base and appendix in a 36-year-old woman. (a) Coronal oblique reformatted multi–detector row CT image shows mild thickening of the cecal base (arrows) and enlargement of the appendix to 8 mm (arrowhead). (b) Multi–detector row CT scan shows features suggestive of a left tubo-ovarian abscess (arrows), a finding that was confirmed surgically.
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Figure 25b. Tubo-ovarian abscess with mild inflammatory reactive changes of the cecal base and appendix in a 36-year-old woman. (a) Coronal oblique reformatted multi–detector row CT image shows mild thickening of the cecal base (arrows) and enlargement of the appendix to 8 mm (arrowhead). (b) Multi–detector row CT scan shows features suggestive of a left tubo-ovarian abscess (arrows), a finding that was confirmed surgically.
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Figure 26. Typhlitis in a 35-year-old man who presented with right lower quadrant pain, fever, and diarrhea. The patient was undergoing chemotherapy. Sagittal oblique reformatted multi–detector row CT image tilted to display the ileocecal junction shows marked thickening of the cecal wall with pronounced submucosal edema (arrow). The appendix is normal, and the terminal ileum is moderately thickened.
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Figure 27a. Typhlitis in a 22-year-old man with myeloblastic acute leukemia with aplasia who presented with sudden, violent right lower quadrant pain with fever. (a) Multi–detector row CT scan through the base of the cecum shows a thickened cecum (black arrow), appendix (arrowhead), and terminal ileum (white arrow). Marked submucosal edema is also seen. A diagnosis of appendicitis was made, and the patient underwent corrective surgery. (b) Oblique reformatted multi–detector row CT image obtained a few days later shows increased edema of the cecum and terminal ileum. The patient responded favorably to several weeks of aggressive treatment. Histologic examination of the appendix revealed inflammatory lesions suggestive of typhlitis.
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Figure 27b. Typhlitis in a 22-year-old man with myeloblastic acute leukemia with aplasia who presented with sudden, violent right lower quadrant pain with fever. (a) Multi–detector row CT scan through the base of the cecum shows a thickened cecum (black arrow), appendix (arrowhead), and terminal ileum (white arrow). Marked submucosal edema is also seen. A diagnosis of appendicitis was made, and the patient underwent corrective surgery. (b) Oblique reformatted multi–detector row CT image obtained a few days later shows increased edema of the cecum and terminal ileum. The patient responded favorably to several weeks of aggressive treatment. Histologic examination of the appendix revealed inflammatory lesions suggestive of typhlitis.
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Figure 28a. Ischemic necrosis of the cecum in a 66-year-old patient who presented with sudden right lower quadrant pain. The patient had a history of cardiac failure with arrhythmia. (a) Coronal oblique reformatted multi–detector row CT image shows cecal wall thickening (arrow). (b) Multi–detector row CT scan demonstrates the presence of air (arrows) in the veins that drain the cecum. Surgery (ileocecal resection) and pathologic findings helped confirm acute ischemic colitis with necrotic colic mucosa but without perforation.
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Figure 28b. Ischemic necrosis of the cecum in a 66-year-old patient who presented with sudden right lower quadrant pain. The patient had a history of cardiac failure with arrhythmia. (a) Coronal oblique reformatted multi–detector row CT image shows cecal wall thickening (arrow). (b) Multi–detector row CT scan demonstrates the presence of air (arrows) in the veins that drain the cecum. Surgery (ileocecal resection) and pathologic findings helped confirm acute ischemic colitis with necrotic colic mucosa but without perforation.
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Figure 29. Volvulus of the cecum. Sagittal reformatted multi–detector row CT image tilted laterally shows the transition zone (arrow) between the opacified colon and the cecum (arrowheads). The cecum is distended, rotated, and located in the left quadrant.
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Copyright © 2006 by the Radiological Society of North America.
