RADIOLOGY CLINICAL IMAGAGING AN ATLAS OF DIFFERENTIAL DAIGNOSIS EISENBERG

1. 65Ileocecal Diseases on
Computed Tomography

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

3. • Fig GI 65-1 Adenocarcinoma (colon). Coronal oblique
reformatted image shows a bulky, irregular
heterogeneous mass (arrows) involving both the cecum
and the terminal ileum with abrupt transition in the
right colon, mild fat stranding (arrowheads), and small
mesenteric lymph nodes.82

4. • Fig GI 65-2 Adenocarcinoma (terminal ileum). Oblique sagittal
reformatted obtained through the ileocecal junction shows
obstructive stenosis of the terminal ileum (arrow) in a woman with
Crohn's disease who presented with a sudden occlusive syndrome.
Surgery revealed a small adenocarcinoma located 2 cm from the
ileocecal valve.82

5. • Fig GI 65-3 Carcinoid tumor (terminal ileum).
Coronal oblique reformatted image shows an ill-
defined, spiculated mesenteric mass (arrows).82

6. • Fig GI 65-4 Non-Hodgkin's lymphoma. Marked
homogeneous symmetric thickening of the cecal wall
without any stenosis of the lumen (arrowhead). There is
large regional and mesenteric lymphadenopathy (arrows).
Note the presence of fat stranding, though it is less severe
than the wall thickening.82

7. • Fig GI 65-5 Metastasis. Large,
hyperattenuating subserosal cecal mass
(arrows) representing metastasis from
hepatocellular carcinoma.82

8. • Fig GI 65-6 Lipoma of the ileocecal valve. Sagittal
oblique reformatted image shows a small, well-defined
fatty mass (arrow) at the level of the ileocecal valve.82

9. • Fig GI 65-7 Mucocele (mucinous appendiceal adenoma).
Coronal oblique reformatted image shows a long cystic
mass (arrowheads) situated close to the base of the cecum
(arrow).82

10. • Fig GI 65-8 Ileoileal intussusception (lead point an inverted
Meckel's diverticulum). Contrast scan demonstrates a
central focus of fat attenuation with concentric rings of
alternating fat and soft-tissue attenuation (arrow). These
findings represent a core of mesenteric fat surrounded by
the wall of the diverticulum and the intestinal wall.82

11. • Fig GI 65-9 Appendicitis. Sagittal oblique
reformatted image shows the full length of an
inflamed appendix (arrowhead) and mild
thickening of the base of the cecum (arrow).82

12. • Fig GI 65-10 Cecal diverticulitis. Coronal oblique
reformatted image shows mild thickening of the
cecal wall, an inflamed enhancing diverticulum
with a thickened wall (arrow), and mild stranding
of peridiverticular and pericecal fat. The patient
had previously undergone an appendectomy.82

13. • Fig GI 65-11 Epiploic appendagitis. Oval,
paracecal fatty mass (arrows) with
surrounding fat stranding.82

14. • Fig GI 65-12 Crohn's disease. Enlarged
appendix (black arrow), stratified symmetric
thickening of the terminal ileum (arrowheads),
and adjacent creeping fat (white arrow).82

15. • Fig GI 65-13 Terminal ileitis. (A) In a young adult with
Campylobacter infection, there is marked thickening of
the cecum (arrowheads) and terminal ileum (arrows)
with preservation of a layered enhancement pattern.
Note the small regional lymph nodes and the absence
of fat stranding.82

16. • Fig GI 65-14 Typhlitis. Thickened cecum (black arrow),
appendix (arrowhead), and terminal ileum (white
arrow), associated with marked submucosal edema, in
a young man with acute myeloblastic leukemia and
sepsis who presented with sudden, violent right lower
quadrant pain and fever.82

17. • Fig GI 65-15 Typhlitis. Marked thickening and
increased enhancement of the fluid-filled
cecum and terminal ileum in a young girl
several months after bone marrow
transplantation for lymphoma.83

18. • Fig GI 65-16 Ischemic necrosis of the cecum.
Prominent thickening of the cecal wall associated
with gas (arrows) in the veins that drain the
cecum. The patient had a history of cardiac
failure with arrhythmia. At surgery, there was
necrotic cecal mucosa without perforation.82