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44 Cards in this Set

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Intramural pseudodiverticula

Case findings:
Multiple contrast-filled cavities, only 1 or 2 millimeter in diameter in the esophageal mucosa
Dilated excretory ducts of deep mucous glands in esophagus

Secondary to esophagitis: pseudodiverticula vanish when the esophagitis is treated (MC Candida)
Dilated submucosal glands and ducts, which are similar to Rokitansky-Aschoff sinuses of GB

DDX:
Moniliasis
Glycogen acanthosis
Esophageal varices

Etiology: portal venous hypertension
Classification
Uphill varices: mid to distal esophagus, portal hypertension
Downhill varices: upper or mid esophagus, SVC obstruction

DDX:
Varicoid carcinoma: superficial spreading carcinoma, with thickened nodular tortuous longitudinal folds
Has a rigid, fixed, nodular folds that do NOT change configuration (unlike varices)
Esophagitis with thickened esophageal folds
Lymphoma
Squamous cell carcinoma
Pharyngeal pouch

Case findings: 
Contrast-filled cavity at the posterior wall of the esophagus 

Arises between the superior and the middle pharyngeal constrictors (congenitally weak point of the pharyngeal wall)

Esophageal diverticula:
Pulsion
Pharyngeal pouch

Case findings:
Contrast-filled cavity at the posterior wall of the esophagus

Arises between the superior and the middle pharyngeal constrictors (congenitally weak point of the pharyngeal wall)

Esophageal diverticula:
Pulsion diverticula: contain no muscle in their wall so they tend to stay filled with barium after the rest of the esophagus empties
Traction diverticula: contain muscle in their walls so they tend to empty with the rest of esophagus

Esophageal diverticulum

Pharyngo-esophageal (Zenker):
Herniation of mucosa and submucosa through oblique and transverse muscle bundles of the cricopharyngeal muscle (pseudodiverticulum)
Increased intraluminal pressures and tic formation in midline of Killian dehiscence at level of C5-C6
MC posterior

Traction diverticulum (interbronchial diverticulum):
Response to pull from fibrous adhesions following lymph node infection (MC TB)
MC right anterior esophageal wall

Distal (epiphrenic diverticulum):
Pulsion, associated with hiatal hernia
MC right
Related to long-standing peptic esophagitis and strictures
Killian-Jamieson diverticulum:
Lateral to the insertion of the longitudinal tendon of the esophagus on the cricoid cartilage

Diverticula are in the mid esophagus can congenital or traction:
Traction types develop by traction from contiguous mediastinal inflammation and adenopathy such as from TB or histoplasmosis

Other causes of mid and lower diverticula:
Iatrogenic
Ehlers-Danlos syndrome
Motility disorders such as achalasia and esophageal spasm

Zenker’s diverticulum

Epiphrenic diverticulum
Large diverticulum (arrows) arising from the posterior wall of the distal esophagus

Traction diverticulum
Traction diverticulum identified by black arrow

MC located in the mid-esophagus

Result from scarring and retraction of the esophageal wall due to granulomatous disease in adjacent subcarinal or hilar lymph nodes

Presence of calcification in subcarinal (white arrows), hilar, or paratracheal lymph nodes  TB
Paraesophageal hernia

Case findings: 
Gastroesophageal junction in normal position
Parts of the stomach slip through the esophageal hiatus

Hiatal hernia:
Sliding: MC (80%), GEJ slides superior into the chest through the esophageal hiatus
Paraeso
Paraesophageal hernia

Case findings:
Gastroesophageal junction in normal position
Parts of the stomach slip through the esophageal hiatus

Hiatal hernia:
Sliding: MC (80%), GEJ slides superior into the chest through the esophageal hiatus
Paraesophageal: GEJ remains in its normal position, but parts of the stomach and peritoneum slip through the esophageal hiatus

Sliding hiatal hernia
Gastric carcinoma

Case findings:
Filling defect in the gastric body

Location: MC pylorus > lesser curve, GEJ, greater curvature
Types:
Polypoid
Ulcerating
Infiltrating or schirrous: linitis plastica
DDX: metastatic breast carcinoma
Superficial spreading: confined to mucosa and submucosa

Predisposing factors:
H. pylori, adenomatous polyps, pernicious anemia, atrophic gastritis

DDX gastric mass
Malignant:
Carcinoma, lymphoma, leiomyosarcoma, metastases

Benign:
Leiomyoma, lipoma, neurofibroma
Polyps:
Hyperplastic
Adenomatous
Hamartomatous

Others:
Bezoar, Nissen fundoplication, ectopic pancreas

Gastric polyps
Hyperplastic (MC)
Adenomatous: increased risk of malignancy
Familial adenomatous polyposis (FAP)
Gardner’s syndrome
Turcot syndrome: associated with CNS tumors (e.g., gliomas)

Hamartomatous:
Peutz-Jeghers syndrome
Cowden syndrome

Inflammatory:
Cronkhite-Canada syndrome
Duodenal diverticulum

Case findings: 
Large duodenal diverticulum with some small diverticula at the top 

MC located near the ampulla 

Intraluminal duodenal diverticulum (2 cases)
Duodenal diverticulum

Case findings:
Large duodenal diverticulum with some small diverticula at the top

MC located near the ampulla

Intraluminal duodenal diverticulum (2 cases)
Celiac disease (sprue)

Case findings: 
Proximal small bowel dilatation
Smudging and dilution of barium in LUQ
Moulage sign: produced by barium reaching such diluted, fluid-filled, hypotonic segments
Normal sized, but widely spaced, sparser folds in
Celiac disease (sprue)

Case findings:
Proximal small bowel dilatation
Smudging and dilution of barium in LUQ
Moulage sign: produced by barium reaching such diluted, fluid-filled, hypotonic segments
Normal sized, but widely spaced, sparser folds in jejunum

Associated with transient intussusception
Risk of intestinal lymphoma

Features:
Small bowel dilatation
Moulage pattern: barium pooling
Flocculation: excessive mucus prevents an adequate coating of the mucosa by the barium (barium flocculates in the presence of mucus)
Jejunization of the ileum: increased number of folds in the ileum, with reversal of the normal jejuno-ileal fold pattern

Jejunization of the ileum

Lymphoma arising in celiac disease as thick, slightly undulating folds (arrows) and smooth nodules (arrowheads)
Crohn’s

Case findings: 
Deep and superficial linear ulcerations and small bowel wall thickening near the terminal ileum
Fistula track

Features:
Deep and superficial linear ulcerations
Cobblestoning
Bowel wall thickening, strictures, skip lesion
Crohn’s

Case findings:
Deep and superficial linear ulcerations and small bowel wall thickening near the terminal ileum
Fistula track

Features:
Deep and superficial linear ulcerations
Cobblestoning
Bowel wall thickening, strictures, skip lesions
Pseudopolyposis, fistula
DDX:
Yersinia colitis: fold thickening (early finding), aphthoid ulcers, coarsened mucosal surface and inflammatory nodules (indistinguishable from early Crohn’s)
Deeper ulceration and marked luminal narrowing is unlikely
Heals to a lymphoid hyperplasia pattern, resolves completely
Ileitis: due to Shigella, Salmonella, Campylobacter
Self-limited and will not reach a stenotic stage
Tuberculosis: identical to Crohn’s
Cobblestoning: deep and superficial linear ulcerations in descending colon
Numerous barium-filled linear clefts are seen as straight, longitudinal and transaxial lines (arrows)

Cobblestones: between the fissures are residual islands of less inflamed mucosa
Confined to the mucosa and submucosa with thickened and curved folds

Long mesenteric border ulcer is seen as a thin barium-filled line (arrows)
Area of ulceration merging with marked narrowing (arrowhead) of the terminal ileum

Small ulcers are also seen in the ascending colon (arrow)
Ulcerative colitis

Case findings:
Loss of haustra and mucosal distortion
Diverticulitis
Case findings:
Irregular bowel wall thickening, with narrowing of the sigmoid lumen
Mucosal pattern preserved (implies a benign process)
Diverticulitis
Case findings:
Irregular bowel wall thickening, with narrowing of the sigmoid lumen
Mucosal pattern preserved (implies a benign process)
Moniliasis

Case findings:
Diffuse nodular and plaque like mucosal defects
Plaque like defects are longitudinally oriented
Sharply defined plaques

DDX:
Glycogen acanthosis
Reflux esophagitis: ill-defined plaques
With progression, esophagus may
Moniliasis

Case findings:
Diffuse nodular and plaque like mucosal defects
Plaque like defects are longitudinally oriented
Sharply defined plaques

DDX:
Glycogen acanthosis
Reflux esophagitis: ill-defined plaques
With progression, esophagus may have a grossly irregular or shaggy contour (shaggy esophagus)

Shaggy contour due to multiple plaques, pseudomembranes, and ulcers
Herpes esophagitis

Multiple small discrete superficial ulcerations: appears as a small barium collection with a surrounding halo of lucency due to edema

No fold thickening, normal esophageal contour

Ulcers may be clustered, MC in mid-esophagus (r
Herpes esophagitis

Multiple small discrete superficial ulcerations: appears as a small barium collection with a surrounding halo of lucency due to edema

No fold thickening, normal esophageal contour

Ulcers may be clustered, MC in mid-esophagus (relative sparing of distal esophagus)

Discrete ulcers surrounded by radiolucent halos of edematous mucosa

Normal intervening mucosa
Glycogen acanthosis

Degenerative condition, MC seen in elderly
Asymptomatic
No risk of malignant degeneration
Features: multiple small, rounded nodules or plaques in the mid or distal esophagus

DDX:
Candida esophagitis (moniliasis): well-defined plaques
Reflux esophagitis: nodular mucosa (ill-defined plaques)
Barrett’s esophagus

Case findings:
Reticular pattern is distal esophagus, adjacent to a stricture in the mid esophagus

Adenocarcinoma arising in Barrett’s esophagus may appear as a flat slightly elevated nodular lesion or as a sessile polyp 
Plaqu
Barrett’s esophagus

Case findings:
Reticular pattern is distal esophagus, adjacent to a stricture in the mid esophagus

Adenocarcinoma arising in Barrett’s esophagus may appear as a flat slightly elevated nodular lesion or as a sessile polyp
Plaque-like tumor: area of nodular mucosa in distal esophagus (arrows) above a hiatal hernia

Edge of plaque-like lesion is seen en face as a white line (arrowhead)
CMV esophagitis

Case findings:
Giant flat ulcer (> 3 cm) on the posterior wall of the distal esophagus with a thin, radiolucent rim of edema

May also present with multiple small ulcers indistinguishable from Herpes esophagitis

DDX giant flat ulcer:
HIV esophagitis
CMV esophagitis
Esophageal leiomyoma

Case findings:
Upper and lower borders of the lesion form slightly obtuse angles (in profile) with the adjacent esophageal wall (submucosal lesion)

DDX submucosal lesion:
MC leiomyoma
LC fibroma, neurofibroma, lipoma, hemangioma, granular cell tumor, squamous papilloma

DDX multiple submucosal lesion:
Granular cell tumor
Neurofibromatosis
Lymphoma
Esophageal carcinoma

Case findings: 
Iinfiltrating esophageal cancers cause irregular narrowing and obstruction of the lumen with nodularity and/or ulceration of the mucosa

MC squamous cell
Types: 
Infiltrating
Polypoid
Ulcerative
Varicoid: su
Esophageal carcinoma

Case findings:
Iinfiltrating esophageal cancers cause irregular narrowing and obstruction of the lumen with nodularity and/or ulceration of the mucosa

MC squamous cell
Types:
Infiltrating
Polypoid
Ulcerative
Varicoid: superficial spreading
Polypoid: lobulated or fungating intraluminal masses, often containing areas of ulceration

Polypoid edge of the tumor is etched in white by barium

Central ulcer protrudes from the expected luminal contour
Advanced infiltrating carcinoma of the mid-esophagus

Varicoid esophageal carcinoma

Focal nodularity in the mid-esophagus due to tiny, coalescent nodules and plaques

DDX:
Moniliasis: localized plaque formation, the plaques tend to have discrete, well-defined borders with normal intervening mucosa
Achalasia

Case findings:
Dilated, aperistaltic esophagus that tapers abruptly to a narrowed, fixed lumen
Tapering is concentric and the lumen contour is absolutely smooth

Primary achalasia:
Result of degeneration of the myenteric plexus innervati
Achalasia

Case findings:
Dilated, aperistaltic esophagus that tapers abruptly to a narrowed, fixed lumen
Tapering is concentric and the lumen contour is absolutely smooth

Primary achalasia:
Result of degeneration of the myenteric plexus innervating the lower esophageal sphincter
Failure of relaxation and lack of coordinating peristalsis (aperistalsis)

Secondary achalasia (pseudoachalasia):
Most carcinomas that cause achalasia are adenocarcinoma arising either in the stomach or in distal esophagus in a Barrett's esophagus
Chagas' disease (trypanosomiasis)

Achalasia (secondary)

Secondary achalasia due to metastasis to GEJ from adenocarcinoma of the mid esophagus

Smooth, tapered narrowing (black arrow) of the distal esophagus just above GEJ

Ulcerated mass (white arrows) in mid esophagus
Annular pancreas

Case findings:
Circumferential narrowing of the 2nd portion of duodenum
Mucosal pattern is preserved
Erosive gastritis

Case findings: 
Multiple erosions present in the antrum of the stomach, seen as small barium-filled ulcer craters with a radiolucent halo (edema) around them

Incomplete linear and serpiginous erosions in the distal stomach (erosiv
Erosive gastritis

Case findings:
Multiple erosions present in the antrum of the stomach, seen as small barium-filled ulcer craters with a radiolucent halo (edema) around them

Incomplete linear and serpiginous erosions in the distal stomach (erosive gastritis)
Etiology:
NSAID, H. Pylori, alcohol, Crohn’s
Associated with gastric atrophy
Atony is common in elderly

Stomach has a tubular appearance
Lack of normal gastric mucosal folds
Areae gastricae may be smaller and irregular in the gastric fundus and body

Case findings:
Smooth, non-distensible antrum
No peristalsis seen on fluoroscopy
Benign gastric ulcer

Large ulcer crater (arrowhead) on greater curvature

Multiple folds (arrows) radiating to the edge of ulcer crater

Folds taper gradually to the edge of the crater

Crater itself extends beyond the outlines of the gastric lum
Benign gastric ulcer

Large ulcer crater (arrowhead) on greater curvature

Multiple folds (arrows) radiating to the edge of ulcer crater

Folds taper gradually to the edge of the crater

Crater itself extends beyond the outlines of the gastric lumen
Supine position: fundus posterior and contains barium

Large ring shadow (arrow) etched-in-white appearance in the gastric antrum (anterior non-dependent wall)
Prone position

Large collection of barium (arrow) in the same area of the gastric antrum (anterior dependent portion)
Ulcer crater protrudes beyond the contour of the stomach
Ulcer is central in the mound (of inflammation and edema) that is smooth and symmetrical

Hampton's line: mucosa is more resistant to ulceration than the fat in the lamina propria and submucosa
Ulcer often spreads laterally in the soft submucosal fat, undermining the mucosa
Undermined mucosa is seen when a gastric ulcer is demonstrated in profile (seen as a thin Hampton's line crossing the ulcer crater)

Folds radiating towards the ulcer crater are smooth and taper towards the crater's edge
No masses associated with the ulcer
Mucosa surrounding the ulcer is not nodular
Ectopic gastric mucosa

Case findings:
Multiple 1-3 mm, polygonally-shaped radiolucent filling defects in the duodenal cap
Crohn’s of the duodenum

Large polygonal nodules covering the mucosal surface of the duodenal cap

2nd part of the duodenum shows mucosal irregularity

Focal eccentric narrowing of the lumen (arrowheads)

Two aphthoid ulcers (arrows) in the proxim
Crohn’s of the duodenum

Large polygonal nodules covering the mucosal surface of the duodenal cap

2nd part of the duodenum shows mucosal irregularity

Focal eccentric narrowing of the lumen (arrowheads)

Two aphthoid ulcers (arrows) in the proximal 2nd part of the duodenum
Gastric volvulus

Mesenteroaxial (this case): 
Stomach has rotated about the gastrohepatic ligament (lesser omentum)

Organoaxial:
Stomach flips superiorly parallel to the longitudinal axis of the organ
Greater curvature lies superior to the lesser
Gastric volvulus

Mesenteroaxial (this case):
Stomach has rotated about the gastrohepatic ligament (lesser omentum)

Organoaxial:
Stomach flips superiorly parallel to the longitudinal axis of the organ
Greater curvature lies superior to the lesser curvature

Oganoaxial gastric volvulus

Gastric volvulus
Organoaxial volvulus of the stomach
Erosive duodenitis

Multiple aphthoid-like small ulcers in the duodenal cap  tiny barium collections surrounded by radiolucent halos of edema

Erosions are seen both en face (arrows) and in profile (arrowhead)
Erosive duodenitis

Multiple aphthoid-like small ulcers in the duodenal cap  tiny barium collections surrounded by radiolucent halos of edema

Erosions are seen both en face (arrows) and in profile (arrowhead)
Duodenal hematoma

Diffuse thickening of the duodenal folds

DDX:
Lymphoma
Gastric bezoar

Complication of subtotal gastrectomy and vagotomy
Poorly chewed fibrous foods, lack of gastric peristalsis, absence of hydrochloric acid
Gastric carcinoma

Sharply circumscribed constricting lesion (arrows) in proximal body

Mucosa is irregular and there are shoulders at the lesion's margins

Segment involved by the tumor is rigid and non-distensible

Gastric (ulcerative) carcinoma
Gastric carcinoma

Sharply circumscribed constricting lesion (arrows) in proximal body

Mucosa is irregular and there are shoulders at the lesion's margins

Segment involved by the tumor is rigid and non-distensible

Gastric (ulcerative) carcinoma

Ulcerated lesion in the body of the stomach with irregularly thickened folds around it

Ulcer crater (black) is rectangular in shape

Surface pattern of the adjacent mucosa (white) is nodular

Nodules are of different sizes and more irregular than the usual areae gastricae pattern

Gastric carcinoma

Diagnosis: gastric carcinoma, linitus plastica

Body and antrum of the stomach are narrowed, rigid

No peristalsis was seen
Diagnosis: ulcerating carcinoma of cardia, with extension into lower esophagus

Irregular shaped ulcer crater (arrows) in gastric cardia

Folds radiating towards the ulcer crater are of uneven thickness, and most do not reach the crater edge

Distal esophagus is narrowed, secondary to proximal extension of the tumor (arrowhead)
Mass in the cardia with thickened folds (arrows)

Normal cardiac rosette is obliterated

Mucosa is coarsely nodular in some areas
Gastrointestinal stromal tumor

Case findings:
Well- circumscribed, smooth-surfaced 3 cm mass in gastric antrum
Barium-filled ulcer crater is centrally located

Ectopic pancreatic rest

Single, smooth-surfaced, relatively flat, polypoid lesion (ar
Gastrointestinal stromal tumor

Case findings:
Well- circumscribed, smooth-surfaced 3 cm mass in gastric antrum
Barium-filled ulcer crater is centrally located

Ectopic pancreatic rest

Single, smooth-surfaced, relatively flat, polypoid lesion (arrow) on the greater curvature of the distal gastric antrum

Gastrointestinal stromal tumor

Large smooth broad-based polypoid lesion (arrows) along distal lesser curvature

Lesion has abrupt margins (arrowheads) with the luminal contour  submucosal mass

Large, solitary submucosal masses of the stomach  MC GIST and lymphoma (about 50% are ulcerated)

DDX: lymphoma
Gastric lymphoma

Loss of the normal gastric rugal pattern, with multiple, large ulcers (large arrows)

Stomach is diffusely narrowed, which is the result of diffuse infiltration by lymphomatous tissue

Well demarcated line (small arrows) in fundus,
Gastric lymphoma

Loss of the normal gastric rugal pattern, with multiple, large ulcers (large arrows)

Stomach is diffusely narrowed, which is the result of diffuse infiltration by lymphomatous tissue

Well demarcated line (small arrows) in fundus, suggesting that the barium is being displaced by a mass effect exerted by the tumor
MC NHL of B-cell origin, arising in the mucosa-associated lymphoid tissue of the stomach (MALT)
Associated H pylori gastritis

Features:
MC appearance an infiltrating lesion
May be focal or diffuse, nodular or smooth thickening of the rugal folds
Gastric wall may either be rigid mimicking scirrhous carcinoma or be pliable due to the soft nature of the lymphomatous infiltrate
Multiple ulcers are often present
Ulcerated submucosal mass
Ulcerating mass with a nodular surface
Carcinoid

Smooth-surfaced, broad-based, sessile polypoid lesion (arrows) in the ileum

Wall opposite the tumor is mildly in-bowed (arrowhead)
DDX sessile polypoid lesion in ileum:
Carcinoid
Gastrointestinal stromal tumor (GIST) 
Lipoma: soft and
Carcinoid

Smooth-surfaced, broad-based, sessile polypoid lesion (arrows) in the ileum

Wall opposite the tumor is mildly in-bowed (arrowhead)
DDX sessile polypoid lesion in ileum:
Carcinoid
Gastrointestinal stromal tumor (GIST)
Lipoma: soft and change size or shape

DDX ileal submucosal lesion:
Metastasis
Disseminated lymphoma
Kaposi's sarcoma
Carcinoid tumor
Polypoid lesion in the terminal ileum (black arrowhead), carcinoid lesion

Ileal diverticula (white arrowheads) and the smooth-surfaced submucosal mass (black arrows) at the entrance of the appendix into the cecum (mucinous cystadenoma of the appendix)

Carcinoid (annular)

Mucosal folds are shown to be preserved (arrow)
Crohn’s

Ulcer (black arrowheads) on the mesenteric border of the distal ileum

Radiolucent collar of edema (arrows) parallels the barium-filled groove

Aphthoid ulcers (white arrowheads)
More extensive along the mesenteric side of the small intest
Crohn’s

Ulcer (black arrowheads) on the mesenteric border of the distal ileum

Radiolucent collar of edema (arrows) parallels the barium-filled groove

Aphthoid ulcers (white arrowheads)
More extensive along the mesenteric side of the small intestine, and extends along vessels and lymphatics entering the small bowel mesentery

Linear mesenteric border ulcer:
Associated with fibrosis and shortening of mesenteric side

Whenever flattening of a mesenteric border is seen in a Crohn's, suspect mesenteric border ulceration

Look on antimesenteric side for sacculations
Mesenteric border ulcer (arrowhead)  folds radiate toward the ulcer

Opposite wall (antimesenteric border) is mildly sacculated (arrows), which is the result of the folds radiating toward the ulcer, and is associated shortening of the mesenteric border
With progressive luminal narrowing and fibrosis of the wall, some of the antimesenteric sacculations survive as diverticula-like outpouchings (arrows)
Crohn’s

DDX of small bowel stricture:
Ischemia: MC solitary, smooth surfaced narrowing, with gradually tapering margins

Radiation: smooth, thick folds perpendicular to the longitudinal axis
If very long-standing, radiation strictures may be smooth
Crohn’s

DDX of small bowel stricture:
Ischemia: MC solitary, smooth surfaced narrowing, with gradually tapering margins

Radiation: smooth, thick folds perpendicular to the longitudinal axis
If very long-standing, radiation strictures may be smooth circumferential tubular narrowing

Neoplasm: annular constricting tumors (primary or metastatic) are sharply demarcated with shoulder formation

Ulcerative colitis: rare, chronic stage of UC with short annular constrictions separating dilated segments are present
Stricture of the terminal ileum (string sign)
Crohn’s

Ileosigmoid fistula due to terminal ileal Crohn's disease
BE: shows reflux of barium into the TI, and a strictured TI
Small bowel ischemia

 Intramural hemorrhage: identical on SBFT  submucosal edema or blood causes thumbprinting, with thickened but straight folds

Barium trapped between the thick folds produces interspace spikes
CT target sign = barium thumbprinti
Small bowel ischemia

Intramural hemorrhage: identical on SBFT  submucosal edema or blood causes thumbprinting, with thickened but straight folds

Barium trapped between the thick folds produces interspace spikes
CT target sign = barium thumbprinting

Etiology of intramural hemorrhage/ischemia:
Low flow states
Emboli or atherosclerosis
Vasculitis: SLE, RA, Behçet's, HSP
Bleeding from hemophilia, ITP, anticoagulation, or intrinsic coagulopathies
Radiation enteropathy
Primary small bowel lymphoma

Grow first by submucosal infiltration longitudinally resulting in thickened valvulae conniventes

Then extends through the thickness of the wall with effacement of valvulae conniventes

Lumen can be mildly narrowed by s
Primary small bowel lymphoma

Grow first by submucosal infiltration longitudinally resulting in thickened valvulae conniventes

Then extends through the thickness of the wall with effacement of valvulae conniventes

Lumen can be mildly narrowed by submucosal lymphoma, but obstruction is uncommon

If the smooth muscle of the wall is destroyed, the lumen can expand (aneurysmal dilatation)
Features:
MC type is infiltrative
2nd MC type is cavitary (ulcerating)

DDX:
Malignant GIST
Metastatic melanoma
Rarely primary adenocarcinoma
May infiltrate short segment of small bowel
Segment of annular narrowing (arrowhead) of the distal jejunum
Borders are abrupt (arrows), but not shelf-like
Normal folds are absent

NOTE: lack of obstruction and relative mild luminal narrowing favor primary lymphoma a over primary adenocarcinoma
Large cavity (white arrows) extends into the small bowel mesentery

Surface of cavity is nodular

Folds of the SB are thick (black arrows)

Large tumor nodules (arrowheads) are seen on the mesenteric border
Meckel’s diverticulum

Case findings:
Smooth-contoured saccular outpouching from the antimesenteric wall of a RLQ ileal loop
No folds are seen in the outpouching

Occurs at obliterated omphalomesenteric duct
Contains all layers of the bowel wall
E
Meckel’s diverticulum

Case findings:
Smooth-contoured saccular outpouching from the antimesenteric wall of a RLQ ileal loop
No folds are seen in the outpouching

Occurs at obliterated omphalomesenteric duct
Contains all layers of the bowel wall
Ectopic gastric mucosa may be present (hemorrhage)
Pertechnetate scan
Junction of the diverticulum with the antimesenteric border of the distal ileum is a narrow neck (arrows)
Scleroderma

Dilated duodenum and jejunum

Despite the massive dilatation, there are 7-8 folds per inch in the first jejunal loop
Dilated duodenum and jejunum

Despite the massive dilatation, there are 7-8 folds per inch in the first jejunal loop
Scleroderma

Dilated duodenum and jejunum

Despite the massive dilatation, there are 7-8 folds per inch in the first jejunal loop
Dilated duodenum and jejunum

Despite the massive dilatation, there are 7-8 folds per inch in the first jejunal loop

Although the number of folds/inch remains is normal (5-6/inch), there are too many folds for the massive luminal dilatation
Lumen is dilated
Folds radiate toward the mesenteric border (arrows) due to asymmetric scarring
Antimesenteric border shows broad-based sacculations (arrowheads)

Classic appearance:
Luminal dilatation
Tethered, crowded folds
Broad based sacculations opposite these folds
Familial adenomatous polyposis

Hamartomatous polyps:
Cowden (multiple hamartoma syndrome): associated with breast and thyroid cancer
Peutz-Jeghers
Multiple hamartomas  MC stomach
Mucocutaneous hyperpigmentation

Adenomatous polyps:
Familial polyposis coli
Turcot: associated with brain tumors (GBM, medulloblastoma)
Gardner’s syndrome: colonic polyps, osteomas (frontal sinus, mandible), ST tumors (desmoid tumors, epidermoid inclusion cysts, fibroma, lipoma, leiomyoma)

Juvenile polyps:
Juvenile polyposis coli
Cronkite-Canada: inflammatory juvenile polyps
Ulcerative colitis

Early ulcerative colitis: 
Colonic mucosa replaced by a diffusely granular appearance
Corresponds to edema and hyperemia, and may precede actual ulceration
Rectum shows diffuse narrowing

Widened presacral space
Ulcerative colitis

Early ulcerative colitis:
Colonic mucosa replaced by a diffusely granular appearance
Corresponds to edema and hyperemia, and may precede actual ulceration
Rectum shows diffuse narrowing

Widened presacral space
Crohn’s

Case findings:
Distal ileum fold thickening and cobble-stoning
Mild transient spasm of this portion of bowel indicating acute inflammation at this site
No skip lesions, obstructions, leaks, or masses

DDX terminal ileum fold thickening:
Crohn's disease
Yersinia infection
Mycobacterium tuberculosis ileitis
Adjacent appendiceal abscess
Mucinous cystadenoma of appendix

Case findings:
BE:
Smooth, sharply outlined, broad based extramucosal mass impressing the apex of the cecum
CT:
Sharply defined round mass in RLQ
Central part has low attenuation
Wall of the lesion is thickened
Peripheral calcification
Crohn’s

Case findings (SBFT):
20cm segment of the terminal ileum is narrowed and non-distensible
Within the right mid abdomen, there is a shorter, approximately 10cm segment of similar narrowing

Early findings:
Aphthoid ulcer: shallow pinpoint mucosal erosions surrounded by an edematous mound
Late findings:
Cobblestone pattern: ulcerations grow and fuse together, forming linear confluent deep ulcerations separated by edematous mucosa
Thickened and distorted folds
String sign: progressive narrowing of the lumen (MC in terminal ileum)a
Rigid, featureless bowel, strictures and obstruction, and foreshortening of bowel

Asymmetric involvement of bowel wall both longitudinally and circumferentially  lesions MC on mesenteric side of intestine
Sinus tract and fistula formation, originating in deep ulcers or fissures

Creeping fat: inflamed mesenteric fat (stranding) accumulate on serosal surfaces
Cecal bascule

Case findings:
BE:
Contrast flowed to the level of what initially appeared to represent the cecum
However, the hugely distended loop of bowel located in the pelvis and extending into the mid-abdomen did not fill with contrast
No “birds beak” sign was demonstrated
CT:
Markedly distended bowel loop in the pelvis

DDX: cecal volvulus
Form of volvulus in which the cecum folds anteromedially in front of the ascending colon, producing a flap-valve occlusion at the site of flexion
Torsion in the transverse plane
Cecum usually falls into the pelvis, resting centrally
Birds beak sign: not present with bascule because there is no true twist

Axial torsion: classic cecal volvulus
Rotation occurs in the longitudinal plane
Cecum turns upward and usually lies in an ectopic location (MC LUQ)
Classic “kidney-bean” appearance

Bascules represent up to 1/3rd of cecal volvuli
Two forms of cecal volvuli have similar presentations and treatments