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CT Imaging of Colitis¹

¹ From the Departments of Radiology (R.F.T.) and Medicine (J.P.C.), University of California San Francisco, 505 Parnassus Ave, PO Box 0628, San Francisco, CA 94143-0628; and Departments of Radiology (R.F.T.) and Medicine (J.P.C.), Division of Gastroenterology, San Francisco General Hospital, San Francisco, Calif. Received May 13, 2005; revision requested July 12; revision received July 26; accepted September 6; final version accepted October 4; final review and update by R.F.T. March 3, 2006. Address correspondence to R.F.T. (e-mail: Ruedi.Thoeni{at}radiology.ucsf.edu).

View larger version (158K): [in a new window]   Figure 1: Transverse CT image of normal rectosigmoid colon in a 45-year-old man. The wall of the rectosigmoid colon (arrows) is enhanced, and the colon is well distended with water.

View larger version (159K): [in a new window]   Figure 2: Transverse CT image in a 34-year-old woman with ulcerative colitis. The wall of the sigmoid is thickened, and hyperemic mesenteric arteries (arrowheads) appear as bright dots next to the outer wall of the colon. This indicates active disease.

View larger version (125K): [in a new window]   Figure 3: Transverse CT image in a 39-year-old man with Crohn disease (granulomatous ileocolitis) shows thickening of the ileocecal tip (arrows) and marked thickening of the terminal ileum (arrowheads). The ileocecal valve is stenosed, as demonstrated by succus in the lumen and prestenotic dilatation.

View larger version (173K): [in a new window]   Figure 4: Transverse CT image in a 45-year-old man with chronic ulcerative colitis. Thickened rectal wall demonstrates the fat halo sign (arrowhead). Perirectal fat (arrows) is increased.

View larger version (154K): [in a new window]   Figure 5: Transverse CT image in a 32-year-old woman with ulcerative colitis and bloody diarrhea demonstrates the double halo, or target, sign with inner (mucosa, arrow) and outer (muscularis propria, arrowhead) rings of high attenuation separated by a ring of low attenuation, which represents submucosa with edema. Little if any pericolonic stranding is seen.

View larger version (169K): [in a new window]   Figure 6: Transverse CT image in a 24-year-old woman with Crohn ileocolitis shows thickening of terminal ileum and cecum (white arrows) with fibrofatty proliferation (arrowheads) in right lower quadrant. One enlarged lymph node (black arrow) is also depicted.

View larger version (138K): [in a new window]   Figure 7: Transverse CT image in a 35-year-old patient with ulcerative colitis and toxic megacolon shows markedly distended transverse colon with shaggy mucosa (arrows).

View larger version (124K): [in a new window]   Figure 8a: CT images in a 37-year-old woman with Crohn disease (ileocolitis). (a) Transverse scan obtained following enteroclysis demonstrates ileoileal (arrow) and ileosigmoidal fistulae (arrowhead). The involved ileal and colonic wall is asymmetrically thickened. (b) Coronal reformation shows ileoileal fistula (arrow) quite well. Contrast enhancement in vagina (arrowheads) is due to an ileovaginal fistula. (Images courtesy of John Lappas, MD, University of Indiana.)

View larger version (119K): [in a new window]   Figure 8b: CT images in a 37-year-old woman with Crohn disease (ileocolitis). (a) Transverse scan obtained following enteroclysis demonstrates ileoileal (arrow) and ileosigmoidal fistulae (arrowhead). The involved ileal and colonic wall is asymmetrically thickened. (b) Coronal reformation shows ileoileal fistula (arrow) quite well. Contrast enhancement in vagina (arrowheads) is due to an ileovaginal fistula. (Images courtesy of John Lappas, MD, University of Indiana.)

View larger version (139K): [in a new window]   Figure 9: Transverse CT image in a 33-year-old man with tuberculous ileocolitis who had recently emigrated from Southeast Asia. The cecal wall (arrows) and terminal ileum (arrowheads) are markedly thickened.

View larger version (168K): [in a new window]   Figure 10: Transverse CT image in a 60-year-old man with fistula formation due to tuberculous colitis. Descending colon appears slightly thickened, and a fistulous tract (white arrows) is shown to extend from the colon to an abscess (black arrow) in the left psoas muscle and through the left paraspinal muscles into the subcutaneous tissue of the back, where another abscess (arrowheads) has formed.

View larger version (162K): [in a new window]   Figure 11a: Transverse CT images in a 31-year-old man with amebiasis who had a history of diarrhea and recent travel to North Africa. (a) Cecal wall is thickened (arrow), but terminal ileum (arrowheads) is not involved. (b) Hepatic flexure (arrows) also demonstrates marked thickening, but descending colon (arrowhead) appears normal.

View larger version (133K): [in a new window]   Figure 11b: Transverse CT images in a 31-year-old man with amebiasis who had a history of diarrhea and recent travel to North Africa. (a) Cecal wall is thickened (arrow), but terminal ileum (arrowheads) is not involved. (b) Hepatic flexure (arrows) also demonstrates marked thickening, but descending colon (arrowhead) appears normal.

View larger version (120K): [in a new window]   Figure 12: Transverse CT image in a 56-year-old man with pseudomembranous colitis who was undergoing antibiotic treatment for endocarditis. In the sigmoid colon, a shaggy thickened bowel wall with alternating areas of necrosis (arrows) and plaques is visible.

View larger version (113K): [in a new window]   Figure 13: Transverse CT image in a 25-year-old man with pseudomembranous colitis who was undergoing antibiotic treatment for sepsis. Extensive wall thickening throughout the colon is evident. The accordion sign (arrows) is seen in the transverse colon, and ascites (arrowheads) is also noted.

View larger version (143K): [in a new window]   Figure 14: Transverse CT image in a 9-year-old girl with myelogenous leukemia and typhlitis demonstrates marked wall thickening in cecum (arrow) and terminal ileum (arrowhead).

View larger version (144K): [in a new window]   Figure 15: Transverse CT image in a 45-year-old male transplantation patient with neutropenic colitis shows marked wall thickening in ascending colon (arrow) associated with pericolonic stranding and ascites (arrowheads).

View larger version (178K): [in a new window]   Figure 16: Transverse CT image in a 71-year-old man with ischemic colitis due to arrhythmia shows ascites and marked thickening of sigmoid colon associated with multiple large nodular defects, which are the CT analog of thumbprinting (arrows) on radiographs. Note that rectal wall (arrowheads) is normal.

View larger version (159K): [in a new window]   Figure 17: Transverse CT image in a 22-year-old woman with ischemic colitis after blunt abdominal trauma to right flank demonstrates marked thickening of hepatic flexure and right colon, with abrupt transition (arrows) between abnormal and normal wall in the transverse colon.

View larger version (151K): [in a new window]   Figure 18a: Ischemic colitis in an 81-year-old woman with myocardial infarction. (a) Anteroposterior CT scout view shows air (arrows) in wall of right colon and small- and large-bowel dilatation. (b) Transverse CT image demonstrates air (arrowheads) in wall of right colon, with lack of wall enhancement and pericolonic stranding indicative of infarction.

View larger version (132K): [in a new window]   Figure 18b: Ischemic colitis in an 81-year-old woman with myocardial infarction. (a) Anteroposterior CT scout view shows air (arrows) in wall of right colon and small- and large-bowel dilatation. (b) Transverse CT image demonstrates air (arrowheads) in wall of right colon, with lack of wall enhancement and pericolonic stranding indicative of infarction.

View larger version (193K): [in a new window]   Figure 19: Transverse CT image in a 65-year-old woman with early diverticulitis who had left lower quadrant pain and leukocytosis reveals wall thickening and multiple small diverticula (arrows) in a long segment of the sigmoid colon. Fascial thickening (arrowheads) along left pelvic side wall indicates mild diverticulitis.

View larger version (150K): [in a new window]   Figure 20: Transverse CT image in a 57-year-old woman with diverticulitis of sigmoid colon shows wall thickening (large arrows) in sigmoid colon and scattered diverticula. An inflamed diverticulum (arrowheads) and mesenteric fluid (small arrow) also are seen.

View larger version (179K): [in a new window]   Figure 21: Transverse thin-section multidetector CT image in a 70-year-old man with diverticulitis and colovesical fistula shows eccentric wall thickening (arrows), pericolonic stranding, and air (arrowhead) in the bladder.

View larger version (137K): [in a new window]   Figure 22: Transverse CT image in a 21-year-old man with right lower quadrant pain due to appendicitis shows an appendicolith (arrowhead) separated from cecal lumen by cecal wall thickening (cecal bar sign) (black arrow). Dilatation of inflamed appendix with air and debris (white arrow) is demonstrated.

View larger version (134K): [in a new window]   Figure 23: Transverse CT image in a 34-year-old man with acute right lower quadrant pain caused by appendicitis with perforation. Appendiceal lumen (short black arrow) is enlarged and shows wall enhancement. Mesenteric stranding (white arrow), free intraperitoneal air (arrowhead), and thickened terminal ileum (long black arrow) due to contiguous inflammation are seen.

View larger version (142K): [in a new window]   Figure 24: Transverse contrast-enhanced CT image in a 25-year-old man with epiploic appendagitis and right upper quadrant pain shows ovoid fatty mass with enhancing rim (arrows) and increased attenuation. Colonic wall is not thickened.

View larger version (192K): [in a new window]   Figure 25: Transverse CT image in a 67-year-old woman with acute right upper quadrant pain due to omental infarction shows ill-defined, ovoid, fatty mass (arrows) of increased attenuation centered in the greater omentum.