Imaging Approach to the Colon

Published on 20/07/2015 by admin

Filed under Radiology

Last modified 22/04/2025

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(Left) Graphic shows a schematic representation of various processes that may narrow the lumen of the colon. Analyzing the borders and placing the lesion in the correct anatomic compartment (mucosal, submucosal, or extrinsic) are the initial steps in developing an appropriate differential diagnosis.

(Right) Spot film from a double-contrast barium enema shows a classic “apple core” lesion . Abrupt, short segment narrowing is typical of malignant lesions.

(Right) Spot film from a double-contrast barium enema shows a classic “apple core” lesion . Abrupt, short segment narrowing is typical of malignant lesions.

Semilunar folds
Ileocecal valve
Appendix
Taeniae coli
Epiploic appendage
Rectal valves
Levator ani muscle
(Top) Graphic shows the surface and mucosal views of the colon. Three flat bands of smooth muscle, the taeniae coli, run the length of the colon. The semilunar folds lie at right angles to the taenia creating the haustra.

Middle colic artery
Right colic artery
Ileocolic artery
Arc of Riolan
Marginal artery (of Drummond)
Superior mesenteric artery
Left colic artery
Inferior mesenteric artery
Sigmoid arteries
(Bottom) The superior mesenteric artery supplies the colon from the appendix through the splenic flexure, with the inferior mesenteric artery supplying the descending colon through the rectum. These arterial branches are highly variable. All are connected by anastomotic arterial arcades and by the marginal artery (of Drummond) and arc of Riolan, which also anastomose with branches of the inferior mesenteric artery that feed the descending and sigmoid colon.

(Left) Surface-rendered endoluminal view from a CT colonography study shows a pedunculated polyp . This 6 mm lesion was subsequently removed via conventional colonoscopy and found to be a benign adenomatous polyp.

(Left) Surface-rendered endoluminal view from a CT colonography study shows a pedunculated polyp . This 6 mm lesion was subsequently removed via conventional colonoscopy and found to be a benign adenomatous polyp.

(Right) Axial image from the same CT colonography study shows the pedunculated polyp outlined by the insufflated carbon dioxide.

(Right) Axial image from the same CT colonography study shows the pedunculated polyp outlined by the insufflated carbon dioxide.

(Left) CT in a 19-year-old man with acute and chronic RLQ pain and a palpable tender mass shows mural thickening of the cecum , with infiltration of the mesentery and enlarged regional nodes .

(Left) CT in a 19-year-old man with acute and chronic RLQ pain and a palpable tender mass shows mural thickening of the cecum , with infiltration of the mesentery and enlarged regional nodes .

(Right) CT in the same case shows similar mural thickening of the terminal ileum . These are typical features of Crohn disease, confirmed in this case, but infectious enteritis may have a similar appearance.

(Right) CT in the same case shows similar mural thickening of the terminal ileum . These are typical features of Crohn disease, confirmed in this case, but infectious enteritis may have a similar appearance.

(Left) CT in an elderly man with acute RLQ pain and a palpable mass shows a dilated appendix , and a circumferential soft tissue density mass in the cecum with extensive invasion into adjacent tissues.

(Left) CT in an elderly man with acute RLQ pain and a palpable mass shows a dilated appendix , and a circumferential soft tissue density mass in the cecum with extensive invasion into adjacent tissues.

(Right) CT in the same case shows an omental soft tissue mass , essentially diagnostic of metastatic malignancy. At surgery, this and the cecal carcinoma were confirmed and resected.

(Right) CT in the same case shows an omental soft tissue mass , essentially diagnostic of metastatic malignancy. At surgery, this and the cecal carcinoma were confirmed and resected.

(Left) Coronal CT in a 69-year-old woman with aortic valve disease, hypertension, acute pain, and hematochezia shows low-density wall thickening of the entire descending and sigmoid colon.

(Right) Axial CT in the same case shows “thumbprinting” of the sigmoid colon and ascites . The rectum was normal. These are classic clinical and CT features of ischemic (hypoperfusion) colitis.

(Right) Axial CT in the same case shows “thumbprinting” of the sigmoid colon and ascites . The rectum was normal. These are classic clinical and CT features of ischemic (hypoperfusion) colitis.

(Left) An 18-year-old girl (and some friends) had acute onset of profuse, bloody diarrhea after eating hamburgers. Coronal CT shows massive submucosal edema affecting the entire colon, including the rectum. These are classic clinical and imaging features of infectious colitis. Enteropathic Escherichia coli (0157: H7 subtype) was the etiology.

(Left) An 18-year-old girl (and some friends) had acute onset of profuse, bloody diarrhea after eating hamburgers. Coronal CT shows massive submucosal edema affecting the entire colon, including the rectum. These are classic clinical and imaging features of infectious colitis. Enteropathic Escherichia coli (0157: H7 subtype) was the etiology.

(Right) Axial CT in the same case shows fluid distention of a thick-walled rectum . The rectum is rarely involved in ischemic colitis.

(Right) Axial CT in the same case shows fluid distention of a thick-walled rectum . The rectum is rarely involved in ischemic colitis.

(Left) This 50-year-old woman had foul-smelling vaginal discharge. Sagittal CT following rectal administration of contrast medium shows contrast filling the rectum , the vagina , and a colovaginal fistulous tract . The cause was diverticulitis, infecting a hysterectomy scar.

(Left) This 50-year-old woman had foul-smelling vaginal discharge. Sagittal CT following rectal administration of contrast medium shows contrast filling the rectum , the vagina , and a colovaginal fistulous tract . The cause was diverticulitis, infecting a hysterectomy scar.

(Right) Axial CT in the same case shows adherence of the rectosigmoid colon to the vaginal cuff with contrast filling the vaginal lumen .

(Right) Axial CT in the same case shows adherence of the rectosigmoid colon to the vaginal cuff with contrast filling the vaginal lumen .

Diagnostic Imaging_ Gastrointes - Michael P Federle