EURORAD ESR

Case 14165

Acute appendicitis in Crohn's disease: CT appearance and clinical significance

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
female, 28 year(s)
 
 
  • Figure 1
    Previous MR-enterography
     

    Despite poor ingestion of polyethylenglycole solution, the ascending colon and caecum (arrowheads) showed moderate (6-7 mm) circumferential mural thickening, without active inflammation and hypervascularity of...

     
    Area of Interest: Colon; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    On post-gadolinium fat-suppressed T1-weighted images minimal enhancement was seen in the thickened caecal wall, without hypervascularity of the surrounding fat (*).

     
    Area of Interest: Colon; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The appendix (arrows) showed normal, collapsed appearance on coronal (c) and sagittal (d) T2-weighted images. Note moderate caecal wall thickening (arrowheads), unremarkable pericaecal fat (*).

     
    Area of Interest: Colon; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The appendix (arrows) showed normal, collapsed appearance on coronal (c) and sagittal (d) T2-weighted images.

     
    Area of Interest: Colon; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 2
    Contrast-enhanced multidetector CT
     

    The ascending colon and caecum showed moderate mural thickening (arrowheads) with stratified appearance due to oedematous submucosa and thin mucosal hyperenhancement (thin arrows). Note mesenterial lymphadenopathies...

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The minimally distended appendix showed development of hyperenhancing mural thickening (arrows) associated with peri-appendiceal inflammatory fat stranding (*) near the appendiceal orifice.

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The minimally distended appendix showed development of hyperenhancing mural thickening (arrows) associated with peri-appendiceal inflammatory fat stranding (*) near the appendiceal orifice.

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Coronal images (d,e) confirmed stratified mural thickening (arrowheads) of ascending colon and caecum with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), appendiceal thickening (arrows) and...

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Coronal images (d,e) confirmed stratified mural thickening (arrowheads) of ascending colon and caecum with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), appendiceal thickening (arrows) and...

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Compared to the stratified caecal wall (arrowheads) with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), the distal ileum (*) did not show significant mural thickening.

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    Compared to the stratified caecal wall (arrowheads) with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), the distal ileum (*) did not show significant mural thickening.

     
    Area of Interest: Colon; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 3
    Bowel ultrasound
     

    Focused ultrasound confirmed normal mural thickness of terminal ileum (3.5 mm, between calipers).

     
    Area of Interest: Colon; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The minimally distended appendix showed thickened stratified wall (arrows) measuring 7-8 mm in thickness (in b), approximately 10 mm at the appendicular orifice (in c).

     
    Area of Interest: Colon; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Inflammation;

    The minimally distended appendix showed thickened stratified wall (arrows) measuring 7-8 mm in hickness (in b), approximately 10 mm nearby the appendicular orifice (in c).

     
    Area of Interest: Colon; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Inflammation;
     
     
  • Figure 4
    Ileo-colonoscopy
     

    The caecum showed minimal, sparse hyperaemic mucosal changes.

     
    Area of Interest: Colon; Imaging Technique: Image manipulation / Reconstruction; Procedure: Endoscopy; Special Focus: Inflammation;

    The appendicular orifice showed marked congestion and inflammation.

     
    Area of Interest: Colon; Imaging Technique: Image manipulation / Reconstruction; Procedure: Endoscopy; Special Focus: Infection;

    With patent ileocaecal valve, the distal ileum (25 cm) showed no visible abnormalities consistent with Crohn's disease.

     
    Area of Interest: Colon; Imaging Technique: Image manipulation / Reconstruction; Procedure: Endoscopy; Special Focus: Inflammation;
     
     
Despite poor ingestion of polyethylenglycole solution, the ascending colon and caecum (arrowheads) showed moderate (6-7 mm) circumferential mural thickening, without active inflammation and hypervascularity of surrounding fat (*).
 
On post-gadolinium fat-suppressed T1-weighted images minimal enhancement was seen in the thickened caecal wall, without hypervascularity of the surrounding fat (*).
 
The appendix (arrows) showed normal, collapsed appearance on coronal (c) and sagittal (d) T2-weighted images. Note moderate caecal wall thickening (arrowheads), unremarkable pericaecal fat (*).
 
The appendix (arrows) showed normal, collapsed appearance on coronal (c) and sagittal (d) T2-weighted images.
 
The ascending colon and caecum showed moderate mural thickening (arrowheads) with stratified appearance due to oedematous submucosa and thin mucosal hyperenhancement (thin arrows). Note mesenterial lymphadenopathies (thick arrow).
 
The minimally distended appendix showed development of hyperenhancing mural thickening (arrows) associated with peri-appendiceal inflammatory fat stranding (*) near the appendiceal orifice.
 
The minimally distended appendix showed development of hyperenhancing mural thickening (arrows) associated with peri-appendiceal inflammatory fat stranding (*) near the appendiceal orifice.
 
Coronal images (d,e) confirmed stratified mural thickening (arrowheads) of ascending colon and caecum with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), appendiceal thickening (arrows) and periappendiceal fat stranding (*).
 
Coronal images (d,e) confirmed stratified mural thickening (arrowheads) of ascending colon and caecum with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), appendiceal thickening (arrows) and periappendiceal fat stranding (*).
 
Compared to the stratified caecal wall (arrowheads) with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), the distal ileum (*) did not show significant mural thickening.
 
Compared to the stratified caecal wall (arrowheads) with oedematous submucosa and thin mucosal hyperenhancement (thin arrows), the distal ileum (*) did not show significant mural thickening.
 
Focused ultrasound confirmed normal mural thickness of terminal ileum (3.5 mm, between calipers).
 
The minimally distended appendix showed thickened stratified wall (arrows) measuring 7-8 mm in thickness (in b), approximately 10 mm at the appendicular orifice (in c).
 
The minimally distended appendix showed thickened stratified wall (arrows) measuring 7-8 mm in hickness (in b), approximately 10 mm nearby the appendicular orifice (in c).
 
The caecum showed minimal, sparse hyperaemic mucosal changes.
 
The appendicular orifice showed marked congestion and inflammation.
 
With patent ileocaecal valve, the distal ileum (25 cm) showed no visible abnormalities consistent with Crohn's disease.
 
 
 
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