Gastrointestinal - Learning Modules - CTisus.com CT Scanning

Learning Modules ❯ Gastrointestinal

CT of the Small Bowel: Inflammatory Disease

Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

CTA of the Small Bowel: Scan Protocol

Oral contrast

Water
Omnipaque-350
VoLumen or Brezza

Intravenous contrast

100-120 cc of Omnipaque-350 or Visipaque-320
Injection rate of 4-5 cc/sec

CT/CTA of the Small Bowel: Applications

Scan Protocol Selection

Arterial phase imaging
Venous phase imaging
Role of non-contrast CT
Role of delayed phase imaging

CT/CTAngiography Protocol: Small BowelArterial Phase (64MDCT and Beyond)

CT Enterography: Crohn’s Disease

Active crohn’s disease findings include

Mucosal hyperenhancement
Wall thickening
Mural stratification (seeing bowel layers) with prominent vasa recta (comb sign)
Mesenteric fat stranding

Crohn’s Disease (Active)

Crohn’s Disease

Crohn’s Disease with Comb Sign and Fibrofatty Spread

Crohn's with Comb Sign

Duodenal Stricture due to Crohn’s Disease

Small Bowel Obstruction due to Crohn’s Disease

Crohn’s with High Grade Dysplasia in Terminal Ileum

Acute Abdomen

Jejunal Diverticulitis

“While diverticulitis of the small bowel is a rare cause of inflammatory disease of the gastrointestinal tract, this condition is associated with a high mortality, which in part is due to a delay in the correct diagnosis. The CT findings in jejunal diverticulitis, although not specific, may suggest this diagnosis. The CT findings in ileal diverticulitis can probably not be differentiated from those of other inflammatory processes in the right lower quadrant. Diverticulitis of the small bowel should be included in the differential diagnosis of intraabdominal inflammatory processes.”
Small-bowel diverticulitis: CT findings
S Greenstein, B Jones, EK Fishman, JL Cameron and SS Siegelman
American Journal of Roentgenology. 1986;147: 271-274

“Jejunal diverticula have characteristic findings on CT, appearing as discrete round or ovoid, contrast-, fluid-, or air-containing structures outside the expected lumen of the small bowel, with a smooth, barely discernible wall and no recognizable small bowel folds. Not infrequently, these structures are seen to communicate directly with an adjoining small-bowel loop, a feature best recognized by scrolling the images. Our experience suggests that jejunal diverticulosis can often be recognized on the basis of the characteristic CT features of this condition.”
Jejunal Diverticulosis: Findings on CT in 28 Patients
Florian Fintelman, Marc S. Levine Stephen E. Rubesin
AJR 2008; 190:1286–1290

Ileal Diverticulitis