CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG

1. 35Narrowing of the Colon

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 35-1 Chronic ulcerative colitis. Fibrosis
and muscular spasm cause shortening and
rigidity of the colon and a loss of haustral
markings.

4. • Fig GI 35-2 Benign stricture in chronic ulcerative
colitis. In addition to the severe narrowing in the
sigmoid colon (closed arrow), there are ulcerative
changes in the upper rectum and proximal
sigmoid colon (open arrow).

5. • Fig GI 35-3 Chronic Crohn's colitis.
Foreshortening and loss of haustra involving
the colon distal to the hepatic flexure simulate
the appearance of chronic ulcerative colitis.

6. • Fig GI 35-4 Ischemic colitis. A stricture in the
descending colon (arrow) followed healing of
the ischemic episode.45

7. • Fig GI 35-5 Amebiasis. Irregular constricting
lesion in the transverse colon. The relatively
long area of involvement tends to favor an
inflammatory etiology.

8. • Fig GI 35-6 Radiation injury. Smooth stricture
of the rectosigmoid developed 18 months
after irradiation.

9. • Fig GI 35-7 Cathartic colon. Bizarre
contractions with irregular areas of narrowing
primarily involve the right colon. Although the
ileocecal valve is gaping, simulating ulcerative
colitis, no ulcerations are identified.

10. • Fig GI 35-8 Caustic colitis. Narrowing of the
midtransverse colon 2 months after a
detergent enema.46

11. • Fig GI 35-9 Annular carcinoma of the sigmoid
colon. The relatively short lesion (arrow) has
sharply defined proximal and distal margins.

12. • Fig GI 35-10 Scirrhous carcinoma of the colon.
The long, circumferentially narrowed area
(arrow) simulates segmental colonic
encasement due to metastatic disease.

13. • Fig GI 35-11 Intraperitoneal metastases from
carcinoma of the pancreas. The nodular mass in
the region of the pouch of Douglas (arrows) was
clinically palpable (Blumer's shelf).

14. • Fig GI 35-12 Intraperitoneal seeding of undifferentiated
carcinoma involving the sigmoid mesocolon. There is a
mass effect and tethering localized to the superior
border of the sigmoid colon (arrow).

15. • Fig GI 35-13 Carcinoma of the colon developing in
a patient with long-standing chronic ulcerative
colitis. There is a long, irregular lesion with a
bizarre pattern in the transverse colon. Note the
pseudopolyps in the visualized portion of the
descending colon.

16. • Fig GI 35-14 Acute sigmoid diverticulitis. Severe
spasm of the sigmoid colon due to the intense
adjacent inflammation. Note the thin projection
of contrast material (arrow) representing
extravasation from the colonic lumen.

17. • Fig GI 35-15 Rectal stenosis due to
suppositories of Veganine.47