Overview and CT Imaging
Examples of Common Colon
Pathologies
Andy Nguyen
Kellie Schenk
Table of Contents
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Normal anatomy
Appendicitis
Diverticulosis
Diverticulitis
Ulcerative colitis
Crohn’s disease
Pseudomembranous
colitis (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
Normal Anatomy
CT Abdomen, Axial view
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Appendicitis
• 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
Note enlargement of the appendix (arrows), intraluminal fluid,
and adjacent inflammatory stranding
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Appendicitis (cont’d)
• Compare to normal
appendix
Normal air-filled appendix (arrow)
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Diverticulosis
• 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
Moderate diverticulosis in the sigmoid colon (arrows)
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Diverticulitis
• Demographics:
• See Diverticulosis
• Clinically:
• Abdominal pain, often
LLQ
• Nausea
• Vomiting
• Constipation or diarrhea
• Fever
Note wall thickening in the sigmoid colon (arrows) and
adjacent inflammatory changes in the pericolic fat
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Ulcerative Colitis
• 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
• Demographics:
• Two peaks of incidence:
15 – 30 and 50 – 80
years old
• Equal incidence in males
and females
• Clinically:
• Abdominal pain
• Diarrhea (usually nonbloody)
• 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
• 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
Note diffuse wall thickening throughout the colon (arrows),
and pericolic inflammation
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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:
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Abdominal pain
Change in bowel habits
Hematochezia or melena
Iron deficiency anemia
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
• 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
• 17 year old Female
• Frequent, bloody
diarrhea with mucus
• Abdominal pain
• Rectal bleeding
• Fever
Diagnosis: Ulcerative colitis
Note mucosal erosions (arrows) and normal luminal caliber and ascites (A)
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Case #3
• 55 year old Male
• Abdominal pain
• Thin, pencil-like
stools
• Melena
• Weight loss
Diagnosis: Adenocarcinoma of the colon
Note 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
Diagnosis: Pseudomembranous colitis
Note 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
• 73 year old
Female
• No symptoms
• Findings
incidentally noted
on abdominal CT
Diagnosis: Diverticulosis
Note diverticuli (arrows)
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Case #6
• 23 year old
Male
• RLQ abdominal
pain
• Nausea
• Vomiting
• Fever
• Loss of appetite
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 Disease
Note 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
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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