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Toxic Megacolon

KEY FACTS Terminology Acute transmural fulminant colitis with colonic dilation and systemic toxicity You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Neutropenic Enterocolitis (Typhlitis)

KEY FACTS Terminology Life-threatening, necrotizing enterocolitis occurring primarily in severely neutropenic patients Imaging Best imaging tool: CECT with multiplanar reformations Massive mural thickening of cecal ± ascending colon wall – Other segments of colon and small bowel can be affected Mucosal hyperenhancement and submucosal edema (marked) Infiltration of pericolonic fat Less common, more severe findings Pneumatosis, extraluminal gas and fluid (perforation) Top Differential Diagnoses Pseudomembranous colitis…

Infectious Colitis

KEY FACTS Terminology Colonic inflammation due to bacterial, viral, fungal, or parasitic infections Imaging Best imaging tool: CECT with multiplanar reformations Mucosal hyperenhancement, marked submucosal edema, ascites Multiple air-fluid levels, inflamed pericolonic fat Ultrasound findings Symmetric wall thickening and submucosal echogenicity Increased mural flow on color Doppler Fluoroscopic findings Used less frequently than before; now supplanted by CT, US, and endoscopy Clostridium difficile , Campylobacter ,…

Colon: Imaging Approach and Differential Diagnosis

Embryology and Congenital Malformations The ascending and transverse colon, along with the small intestine, are part of the embryologic midgut, which undergoes marked elongation beginning in the 6th week of fetal development. To accommodate this increased length, the midgut herniates into the base of the umbilical cord. During the 10th week, it returns to the abdomen while undergoing a complex series of rotations and fixations. All…

Hamartomatous Polyposis Syndromes

KEY FACTS Terminology Spectrum of hereditary and nonhereditary polyposis syndromes characterized by gastrointestinal (GI) tract polyps and other associated lesions Imaging CT enterography is best imaging tool (multiplanar, contrast enhanced) Best diagnostic clue Cluster of small filling defects in small bowel (SB) with intussusception Peutz-Jeghers syndrome (PJS) Jejunum and ileum > duodenum > colon > stomach Top Differential Diagnoses Familial adenomatous polyposis and related syndromes Brunner…

Small Intestine Transplantation

KEY FACTS Terminology Isolated small bowel transplant (SB Tx) is primarily for "short gut syndrome" Multivisceral Tx (liver, ± pancreas, ± part of stomach) Usually for liver failure due to chronic total parenteral nutrition (TPN) Donor bowel has copious lymphoid tissue and bacteria Higher prevalence of rejection and infectious complications than solid visceral Txs Imaging Vascular complications: Thrombosis, stricture, pseudoaneurysm (arteries or veins) Less common than…

Bowel Ischemia

KEY FACTS Terminology Small bowel (SB) ischemia resulting from mesenteric arterial or venous narrowing or occlusion, leading to inadequate supply of nutrients and oxygen Imaging Best imaging tool CT angiography; multiplanar reformations; water for oral contrast Catheter angiography for confirmation & treatment Imaging findings vary, based on etiology and acuity of ischemic injury Acute arterial thrombosis or embolus Little SB wall thickening, mesenteric edema, or ascites…

Pneumatosis of the Intestine

KEY FACTS Terminology Pneumatosis is descriptive sign, not disease or diagnosis Cystic or linear collections of gas in subserosal or submucosal layers of GI tract wall Pneumatosis intestinalis: Most common form of intramural gas, found in small bowel more often than colon Pneumatosis coli: Rounded collections of gas in distal colonic wall, usually asymptomatic finding You’re Reading a Preview Become a Clinical Tree membership for Full…

Crohn’s Disease

KEY FACTS Terminology Disease of unknown etiology characterized by transmural inflammation of GI tract Imaging CT and MR enterography have supplanted most barium studies for diagnosis in adults and children Faster to perform, less operator dependent, more sensitive and specific Allow assessment of extraintestinal disease (e.g., cholangitis; arthritis) Multiplanar CT or MR enterography Distend bowel with water ± neutral contrast agent (e.g., VoLumen) Bolus IV contrast medium…

Whipple Disease

KEY FACTS Terminology Rare systemic disease caused by Tropheryma whipplei infection leading to multiple systemic manifestations, including chronic diarrhea and malabsorption You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Intestinal Lymphangiectasia

KEY FACTS Terminology Primary intestinal lymphangiectasia (Waldmann disease) Rare congenital disorder characterized by hypoproteinemia, peripheral edema, and lymphocytopenia resulting from loss of lymphatic fluid into intestine Important cause of protein-losing enteropathy Secondary: Much more common Causes include mesenteric or retroperitoneal node dissection (obliterates lymphatics) Right heart failure; fibrosing mesenteritis; retroperitoneal fibrosis are also implicated Imaging Contrast-enhanced, multiplanar CT is 1st-line imaging test Diffuse small bowel (SB)…