Different Aspects of Colitis

As Shown in
Barium Studies

S. Rad
With Selected Cases From His Own Teaching Files

Tabriz University of Medical Sciences

Tabriz-Iran

1 .S. R Feb 16, 2009

 Remark
Single and double contrast barium
studies are efficiently used to delineate
luminal or mucosal changes that are
essential to diagnose in inflammatory
.)bowel diseases )IBD
The purpose of showing following
examples is to emphasis on the
radiological findings for each of the
.more common insults

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 Collar-button
ulcer

Circular collar-button ulcers are usually found in preliminary

.states
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 Wide spread tiny ulcerations are sometimes confused with feces
.inside colon

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 Lack of colon haustrations favors discrimination of colitis from
.feces
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 Proctitis is
usually the
precursor of
IBD

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 Descending colon thanks to its muscular tonus best
.shows lack of haustrations and swelling of mucosa
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 L
Undermining

Undermining of the
ulcers produces
some kind of
tracking between
.them
Undermining

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 Pseudo-polyp

Pseudo-polyp

Surrounding ulcers around normal parcels of mucosa creates

.pseudo-polyps

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 Pseudo-polyps

.To see the pseudo-polyps air and barium covering is necessary

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 .Double contrast better delineates superficial ulcerations
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 Toxic mega-colon

Active phase

Fibrotic
narrowing in
chronic phase

.Different episodes of IBD may be seen in one film

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 Cobble-
stone
.appearance

Cobble-stoning is the
familiar aspect of IBD
seen here in
.descending colon

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 Negative aspect is much
more suitable to show cobble-
stoning and undermining

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 .Involvement of the left colon is much more common in IBD

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 Pan-colitis may involve whole
length of the colon and is
prone to malignant
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.degeneration .S. R Feb 16, 2009
 .Right colon is the last part to be involved in IBD

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 The same
patient to
show the
incompetency
of the ileo-
cecal valve
for later
extension of
.inflammation
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 .Fairly normal pattern in the right colon

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 .Rigidity of the colon in long segment is named lead-pipe sign
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 .Segmental narrowing creates lead-pipe appearance

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 Lead-pipe sign in the transverse and descending colon

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 Fibrotic narrowing

Lead-pipe sign with fibrotic narrowing

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 Extension of the inflammatory process to terminal ileum is
.called back-wash ileitis
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 Chronic ulcerativecolitis with back-wash ileitis
.showing dilatation of the terminal ileum
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 Conclusion
Although inflammatory bowel diseases are
easily diagnosed and differentiated from
neoplasm but apart from some
characteristic signs, recognition of the
inflammation types is not so easy because
.of overlapping of the similar patterns

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 Thanks for your attention

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