65 Ileocecal Diseases on Computed Tomography

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 65-1 Adenocarcinoma (colon). Coronal oblique reformatted image shows a bulky, irregular heterogeneous mass (arrows) involving both the cecum and the terminal ileum with abrupt transition in the right colon, mild fat stranding (arrowheads), and small mesenteric lymph nodes.82

• Fig GI 65-2 Adenocarcinoma (terminal ileum). Oblique sagittal reformatted obtained through the ileocecal junction shows obstructive stenosis of the terminal ileum (arrow) in a woman with Crohn's disease who presented with a sudden occlusive syndrome. Surgery revealed a small adenocarcinoma located 2 cm from the ileocecal valve.82

• Fig GI 65-3 Carcinoid tumor (terminal ileum). Coronal oblique reformatted image shows an ill-defined, spiculated mesenteric mass (arrows).82

• Fig GI 65-4 Non-Hodgkin's lymphoma. Marked homogeneous symmetric thickening of the cecal wall without any stenosis of the lumen (arrowhead). There is large regional and mesenteric lymphadenopathy (arrows). Note the presence of fat stranding, though it is less severe than the wall thickening.82

• Fig GI 65-5 Metastasis. Large, hyperattenuating subserosal cecal mass (arrows) representing metastasis from hepatocellular carcinoma.82

• Fig GI 65-6 Lipoma of the ileocecal valve. Sagittal oblique reformatted image shows a small, well-defined fatty mass (arrow) at the level of the ileocecal valve.82

• Fig GI 65-7 Mucocele (mucinous appendiceal adenoma). Coronal oblique reformatted image shows a long cystic mass (arrowheads) situated close to the base of the cecum (arrow).82

• Fig GI 65-8 Ileoileal intussusception (lead point an inverted Meckel's diverticulum). Contrast scan demonstrates 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.82

• Fig GI 65-9 Appendicitis. Sagittal oblique reformatted image shows the full length of an inflamed appendix (arrowhead) and mild thickening of the base of the cecum (arrow).82

• Fig GI 65-10 Cecal diverticulitis. Coronal oblique reformatted image shows mild thickening of the cecal wall, an inflamed enhancing diverticulum with a thickened wall (arrow), and mild stranding of peridiverticular and pericecal fat. The patient had previously undergone an appendectomy.82

• Fig GI 65-11 Epiploic appendagitis. Oval, paracecal fatty mass (arrows) with surrounding fat stranding.82

• Fig GI 65-12 Crohn's disease. Enlarged appendix (black arrow), stratified symmetric thickening of the terminal ileum (arrowheads), and adjacent creeping fat (white arrow).82

• Fig GI 65-13 Terminal ileitis. (A) In a young adult with Campylobacter infection, there is 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.82

• Fig GI 65-14 Typhlitis. Thickened cecum (black arrow), appendix (arrowhead), and terminal ileum (white arrow), associated with marked submucosal edema, in a young man with acute myeloblastic leukemia and sepsis who presented with sudden, violent right lower quadrant pain and fever.82

• Fig GI 65-15 Typhlitis. Marked thickening and increased enhancement of the fluid-filled cecum and terminal ileum in a young girl several months after bone marrow transplantation for lymphoma.83

• Fig GI 65-16 Ischemic necrosis of the cecum. Prominent thickening of the cecal wall associated with gas (arrows) in the veins that drain the cecum. The patient had a history of cardiac failure with arrhythmia. At surgery, there was necrotic cecal mucosa without perforation.82