Combined F-18 FDG positron emission tomography/computed tomography in the diagnosis of colonic polyps: the potential and limitations of the technique.
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A computed tomographic evaluation of adult ileocolic intussusception secondary to polypoid adenocarcinoma is presented. The observed tapering homogeneous peripheral mantle and mixed density core may be characteristic for this entity.
Two cases of pseudomyxoma peritonei with intraabdominal abscess formation are presented. In both cases the presence and the extent of abscess were diagnosed by computed tomography (CT). In addition, in each case the source of the abscess was also suggested by CT.
Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.
In a 36-year-old man with neurofibromatosis type 1, rare colonic involvement of plexiform neurofibroma is presented. The diagnosis was confirmed by operation. Radiologic findings consisted of marked concentric thickening of the colonic wall with variable attenuation, namely, a "multilayer appearance," as well as clusters of multiple soft tissue nodules in the mesentery.
Carcinoma of the colon in a 39-year-old woman which caused obstruction and inflammation of the appendiceal lumen remained undetected until postappendectomy complications prompted reevaluation and appropriate surgical intervention. Malignant lesions of the colon, especially the right side, are occurring with increasing frequency in young persons, and delay in recognition and definitive treatment is responsible for poor survival. A high index of suspicion in patients with atypical presentation of appendicitis or unusual operative findings should provide an opportunity for early diagnosis of underlying carcinoma.
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A 32-year-old man with a 12-year history of Crohn's disease of the colon was found to have a 5-cm cecal mass on colonoscopy. Histology examination of the lesion revealed high-grade B-cell lymphoma of Burkitt's type. He was treated with chemotherapy and has done well in the past 12 months. Review of the literature reveals 30 cases of lymphoma in patients with a history of Crohn's disease.
A 7-year-old boy developed recurrent abdominal pain. He was eventually discovered to have an inverted appendix via colonoscopy. At surgery, a polyploid intracecal mass was palpated at the base of the partially invaginated appendix. Resection of the cecal mass (histologically, a juvenile polyp) and appendix was easily accomplished. The types of clinical presentation and treatment of children with appendiceal intussusception are discussed.
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Polymyositis in an elderly but alert man led to an intensive search for an occult malignancy, which was found and removed. A five-year follow-up without evidence of metastasis supports the concept that polymyositis may antedate metastasis of underlying carcinoma and provide an opportunity for diagnosis and excision of the tumor before it has spread.
We reviewed the clinical data and pathologic material on 46 patients with lesions originally interpreted as appendiceal mucocele or mucinous adenocarcinoma from two medical centers. The mucoceles, characterized by accumulation of mucus in a dilated lumen, could be divided into three distinct entities: nonneoplastic retention mucoceles (eight cases), cystadenomas (26 cases), and cystadenocarcinomas (eight cases). There were four mucinous adenocarcinomas. Retention mucoceles are associated with little morbidity and are cured by appendectomy. Cystadenomas and cystadenocarcinomas mimic the behavior of ovarian neoplasms of borderline malignant potential. Some of these lesions were associated with pseudomyxoma peritonei, but did not have systemic metastases. Mucinous adenocarcinomas without mucocele mimic the behavior of ordinary large bowel carcinoma.
We have reported the recent case of a patient with three synchronous colonic malignancies. A review of the literature suggests that multiple lesions of the colon, particularly ones that are benign, are not uncommon. The clinician should be aware of this association and be prepared to evaluate and manage appropriately patients with multiple colonic lesions.
In the diagnosis of intra-abdominal disease, absence of gas or fecal shadows from the right iliac fossa is an important but nonspecific finding on plain roentgenograms. We found the empty right iliac fossa most commonly associated with acute appendicitis, Crohn's disease, and carcinoma of the cecum. Retrospective analysis of 137 confirmed cases of disease in the right lower quadrant yielded 21 (15.4%) with an empty right iliac fossa. In an additional 21 cases, an empty right iliac fossa was prospectively identified, and 13 of these patients (61.9%) had confirmed disease in a particular area.