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Overview and CT Imaging Examples of Common Colon PathologiesAndy Nguyen
Kellie Schenk
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Table of Contents• Normal anatomy• Appendicitis• Diverticulosis• Diverticulitis• Ulcerative colitis• Crohn’s disease• Pseudomembranous c
olitis (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
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Normal Anatomy
Return to Table of ContentsCT Abdomen, Axial view
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Appendicitis
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Note enlargement of the appendix (arrows), intraluminal fluid, and adjacent inflammatory stranding
• Demographics:• Any age, most commonly
10-30 years old• Slightly more common in
males (1.4 : 1)
• Clinically:• Abdominal pain, often
RLQ• Nausea• Vomiting• Fever
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Appendicitis (cont’d)
• Compare to normal appendix
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Normal air-filled appendix (arrow)
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Diverticulosis
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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
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Diverticulitis
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Note wall thickening in the sigmoid colon (arrows) and adjacent inflammatory changes in the pericolic fat
• Demographics:• See Diverticulosis
• Clinically:• Abdominal pain, often
LLQ• Nausea• Vomiting• Constipation or diarrhea• Fever
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Ulcerative Colitis
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• 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
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Crohn’s Disease
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• 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
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Pseudomembranous colitis
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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
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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
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Note circumferential thickening of the cecum (curved arrows) and a hypodense focus within the wall which is due to necrosis (straight arrow)
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Quiz Cases
• Image presented first• Clinical history provided second• Diagnosis given last
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Case #1
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• 71 year old Male• LLQ abdominal
pain• Constipation• Nausea• Vomiting• Fever
Diagnosis: Diverticulitis Note diverticuli (arrows) and fascial thickening (arrowheads), indicating diverticulitis
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Case #2
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• 17 year old Female• Frequent, bloody
diarrhea with mucus• Abdominal pain• Rectal bleeding• Fever
Diagnosis: Ulcerative colitisNote mucosal erosions (arrows) and normal luminal caliber and ascites (A)
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Case #3
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• 55 year old Male• Abdominal pain• Thin, pencil-like
stools• Melena• Weight loss
Diagnosis: Adenocarcinoma of the colonNote erosion into the anterior abdominal wall (arrow)
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Case #4• 61 year old
Female• Abdominal pain• Fever• 8 episodes of
diarrhea / day• Recently treated
for bacterial sinusitus
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Diagnosis: Pseudomembranous colitisNote 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)
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Case #5
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• 73 year old Female
• No symptoms• Findings
incidentally noted on abdominal CT
Diagnosis: DiverticulosisNote diverticuli (arrows)
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Case #6• 23 year old
Male • RLQ abdominal
pain• Nausea• Vomiting• Fever• Loss of appetite
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Diagnosis: Appendicitis
Note the dilated, fluid-filled appendix (arrows) and inflammatory changes in the adjacent fat
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Case #7
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• 53 year old Female• Abdominal pain• Steatorrhea• Diarrhea• Fatigue
Diagnosis: Crohn’s DiseaseNote thickening of the terminal ileum and cecum (white arrows) along with fibrofatty proliferation (arrowheads). An enlarged lymph node is also visible (black arrow)
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References• Horton KM, Corl FM, Fishman EK. CT Evaluation of the Colon: Inflammatory Disease. Radiographics,
March 2000 20:2 399-418• 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;623-638• http://www.meddean.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/bowel_obstruction.htm• http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Surgery/Diveriticulitis1.htm• Demographic information and clinical signs/symptoms: www.uptodate.com