Diagnostic Ultrasound - Abdomen and Pelvis
Bowel Wall Thickening Crohn Disease Crohn Disease (Left) Axial transabdominal US of the descending colon shows circumferential thickening with preservation of the gut signature. Note the echogenic prominent submucosal layer . This was histologically proven to be Crohn colitis. (Right) Long axis US shows the same thickened segment of descending colon with preservation of the gut signature and prominent echogenic submucosal layer , representing fibrofatty proliferation in chronic Crohn disease. Note some increased flow on color flow mapping. Differential Diagnoses: Bowel Adenocarcinoma Adenocarcinoma (Left) Asymmetrical lobular thickening of a short segment of proximal transverse colon is shown, representing colonic carcinoma. Note the loss of the gut signature. The central lumen has an irregular outline ſt, representing ulceration. (Right) Short axis US of hepatic flexure shows infiltrative carcinoma with loss of mural stratification and central luminal narrowing ſt. Note extramural tumor infiltration of the anterior abdominal wall . Lymphoma Lymphoma (Left) Circumferential hypoechoic wall thickening ſt of the gastric wall with loss of the gut signature is shown. This was histologically proven to be lymphoma, abutting the left lobe of the liver . (Right) Axial CECT in the same patient shows circumferential thickening ſt. There is no luminal narrowing. The left lobe of the liver is noted. 1003
Bowel Wall Thickening Differential Diagnoses: Bowel (Left) Oblique axial US through the right iliac fossa shows an oval hypoechoic focal mural mass in the terminal ileum, histologically proven to be a carcinoid. Note the gut signature in the remainder of the bowel. The hypoechoic outer layer represents the muscularis propria layer ſt. (Right) Axial CT in the same patient shows the enhancing tumor in the terminal ileum . Carcinoid Carcinoid (Left) Oblique US of the left iliac fossa through the long axis of sigmoid colon shows thickening of the outer hypoechoic muscular layer ſt and thick-walled inflamed diverticula with echogenic material (air/fecal material). Note the surrounding inflamed echogenic fat . (Right) Short axis US shows the "bowel within bowel" appearance from intussusception. Note the outer edematous intussuscipiens st, the central intussusceptum ſt, and intervening fluid . Diverticulosis/Diverticulitis Intussusception (Left) Longitudinal US shows a long segment of small bowel with acute mural edema ſt (note edematous hypoechoic submucous layer st), resulting in thickening secondary to acute superior mesenteric venous thrombosis. There is ascites . (Right) Axial CECT in the same patient shows the same segment with acute mural edema ſt. Note the presence of ascites in this patient with known cirrhosis of the liver. Acute Venous Ischemia Acute Venous Ischemia 1004
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Bowel Wall Thickening<br />
Crohn Disease<br />
Crohn Disease<br />
(Left) Axial transabdominal US<br />
of the descending colon shows<br />
circumferential thickening<br />
with preservation of the gut<br />
signature. Note the echogenic<br />
prominent submucosal layer<br />
. This was histologically<br />
proven to be Crohn colitis.<br />
(Right) Long axis US shows the<br />
same thickened segment of<br />
descending colon with<br />
preservation of the gut<br />
signature <strong>and</strong> prominent<br />
echogenic submucosal layer<br />
, representing fibrofatty<br />
proliferation in chronic Crohn<br />
disease. Note some increased<br />
flow on color flow mapping.<br />
Differential Diagnoses: Bowel<br />
Adenocarcinoma<br />
Adenocarcinoma<br />
(Left) Asymmetrical lobular<br />
thickening of a short segment<br />
of proximal transverse colon is<br />
shown, representing colonic<br />
carcinoma. Note the loss of<br />
the gut signature. The central<br />
lumen has an irregular outline<br />
ſt, representing ulceration.<br />
(Right) Short axis US of<br />
hepatic flexure shows<br />
infiltrative carcinoma with<br />
loss of mural stratification <strong>and</strong><br />
central luminal narrowing ſt.<br />
Note extramural tumor<br />
infiltration of the anterior<br />
abdominal wall .<br />
Lymphoma<br />
Lymphoma<br />
(Left) Circumferential<br />
hypoechoic wall thickening ſt<br />
of the gastric wall with loss of<br />
the gut signature is shown.<br />
This was histologically proven<br />
to be lymphoma, abutting the<br />
left lobe of the liver .<br />
(Right) Axial CECT in the same<br />
patient shows circumferential<br />
thickening ſt. There is no<br />
luminal narrowing. The left<br />
lobe of the liver is noted.<br />
1003
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