Crohn’s Disease: Errors of Interpretation in Emergency MDCT Evaluation

  • Luigia Romano
  • Maria Giuseppina Scuderi
  • Stefania Daniele


Computed tomography (CT) is increasingly being used as a screening modality for patients with symptoms of acute abdomen. As such, it has become the preferred small bowel imaging approach for assessing intestinal disorders. However, errors in the interpretation of the intestinal radiological CT findings are a common occurrence in acute conditions, given the large spectrum of pathologies, including inflammatory, infectious, vascular, and neoplastic diseases. In fact the differential diagnosis is often challenging, as intestinal emergency findings are similar, such that pitfalls are common.


Bowel Wall Compute Tomography Finding Radiation Enteritis Thicken Bowel Wall Intestinal Lymphoma 
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  1. 1.
    Wills JS, Lobis IF, Denstman FJ et al (1997) Crohn disease: state of the art. Radiology 202:597–610PubMedGoogle Scholar
  2. 2.
    Gourtsoyiannis N, Papanikolau N, Grammatikakis J et al (2000) Magnetic resonance imaging of the small bowel using a true-FISP sequence after enteroclysis with water solution. Invest Radiol 12:2651–2658Google Scholar
  3. 3.
    Karahan OI, Dodd GD III, Chintapalli KN et al (2000) Gastrointestinal wall thickening in patients with cirrhosis: frequency and patterns on contrast enhanced CT. Radiology 215:103–107PubMedGoogle Scholar
  4. 4.
    Horton KM, Corl FM, Fishman EK et al (2000) CT evaluation of the colon: inflammatory disease. RadioGraphics 20:399–418PubMedGoogle Scholar
  5. 5.
    Phillpotts LE, Heiken JP, Westcott MA et al (1994) Colitis: use of CT findings in differential diagnosis. Radiology 190:445–449Google Scholar
  6. 6.
    Gore RM, Balthazar EJ, Ghahremani GG et al (1996) CT features of ulcerative colitis and Chron’s disease. AJR 167:3–15PubMedGoogle Scholar
  7. 7.
    Tomei E, Discinti D, Marini M et al (1996) Computed Tomography of bowel wall in patients with Crohn’s disease: relationship of inflammatory activity to biological indices. Ital J Gastroenterol 28:487–492PubMedGoogle Scholar
  8. 8.
    Rha SE, Ha HK, Lee SH et al (2000) CT and MR imaging features of bowel ischemia from various primary causes. RadioGraphics 20:29–42PubMedGoogle Scholar
  9. 9.
    Horton KM, Abrams RA, Fishman EK (2000) Spiral CT of colon cancer: imaging features and role in management. RadioGraphics 20:419–430PubMedGoogle Scholar
  10. 10.
    Sivit CJ, Taylor GA, Bulas DL et al (1992) Post traumatic shock in children: CT findings associated with hemodynamic instability. Radiology 182:723–726PubMedGoogle Scholar
  11. 11.
    Mirvis SE, Shanmuganathan K, Erb R (1994) Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. AJR 163:1375–1379PubMedGoogle Scholar
  12. 12.
    Gore RM, Marn CS, Kirby DF et al (1984) CT findings in ulcerative, granulomatous and indeterminate colitis. AJR 143:279–284PubMedGoogle Scholar
  13. 13.
    Baltazar EJ (1991) CT of the gastrointestinal tract: principles and interpretation. AJR 156:23–32Google Scholar
  14. 14.
    Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. RadioGraphics 20:399–418PubMedGoogle Scholar
  15. 15.
    Macari M, Balthazar EJ (2001) CT of bowel wall thickening: significance and pitfalls of interpretation. AJR 176:1105–116PubMedGoogle Scholar
  16. 16.
    Jones B, Fishmann EK, Hamilton SR et al (1986) Submucosal accumulation of fat in inflammatory bowel disease: CT pathologic correlation. J Comput Assist Tomogr 10:759–763PubMedCrossRefGoogle Scholar
  17. 17.
    Muldowney SM, Baife DM, Hammermann A et al (1995) “Acute” fat deposition in bowel wall submucosa: CT appearance. J Comput Assist Tomogr 19:390–393PubMedCrossRefGoogle Scholar
  18. 18.
    Meyers MA, McGuire PV (1995) Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or “the comb sign”. Abdom Imaging 20:327–332PubMedCrossRefGoogle Scholar
  19. 19.
    Giovagnorio F, Discinti D, Vernis P (1998) Doppler sonography of the superior mesenteric artery in Crohn’s disease. AJR 170:123–126PubMedGoogle Scholar
  20. 20.
    Lee SS, Ha HK, Yang SK et al (2002) CT of prominent pericolic or perienteric vasculature in patients with Crohn’s disease: correlation with clinical disease activity and findings on barium studies. AJR 179:1029–1036PubMedGoogle Scholar
  21. 21.
    Byun JY, Ha HK, Yu SY et al (1999) CT features of systemic lupus erythematosus in patients with acute abdominal pain: emphasis on ischemic bowel disease. Radiology 211:203–209PubMedGoogle Scholar
  22. 22.
    Kim JK, Ha HK, Byun JY et al (2001) CT differentiation of mesenteric ischemia due to vasculitis and thromboembolic disease. J Comput Assist Tomogr 25:604–611PubMedCrossRefGoogle Scholar
  23. 23.
    Blumeke DA, Fishman EK, Kuhlman JE et al (1991) Complications of radiation therapy: CT evaluation. RadioGraphics 11:581–600Google Scholar
  24. 24.
    Bodly KD, Fletcher JG, Solem CA et al (2006) Crohn disease mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation. Radiology 238:505–516CrossRefGoogle Scholar
  25. 25.
    Bruining DH, Siddiki HA, Fletcher Jg et al (2008) Prevalence of penetrating disease and extraintestinal manifestations of Crohn’s disease detected with CT enterography. Inflamm Bowel Dis 14:1701–1706PubMedCrossRefGoogle Scholar
  26. 26.
    Podolsky DK (1991) Inflammatory bowel disease. N Engl J Med 325:928–937PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Luigia Romano
    • 1
  • Maria Giuseppina Scuderi
    • 1
  • Stefania Daniele
    • 1
  1. 1.Department of Diagnostic Radiological Imaging“A. Cardarelli” HospitalNaplesItaly

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