Collapse and Contraction

Luminal collapse can be confused with malignant scirrhous tumors by radiologists learning CT colo-nography (Fidler et al. 2004). Imaging patients in two positions has been shown by multiple observers to result in complementary distension and can be employed to distend collapsed bowel (Chen et al. 1999; Fletcher et al. 2000; Yee et al. 2003). In general, the patient should be rolled such that the collapsed bowel loop is in the most nondependent location (Fig. 14.7). Contraction can appear as a focal area of wall thickening, which can mimic an annular-constricting lesion. Delayed imaging in another position usually will allow for the colonic bowel segment to relax (Fig. 14.8). Alternatively glucagon can be given when this is suspected. In our experience annular constricting neoplasms, which do not have well-defined soft tissue shoulders, can be mistaken for collapse by inexperienced readers (Fig. 14.9). These lesions will retain the marked colonic wall thickening and irregularity to the intraluminal margins of the mass, potentially b a c

Fig. 14.5a,b. Complex colonic folds can mimic polyps on 2D images. These folds are particularly common in the colonic flexures They can easily be recognized by comparing: a 2D image (arrows); b 3D endoluminal image (arrows)
Fig. 14.6.a Thickened folds in a suboptimally distended sigmoid colon (arrows). b Repositioning distends the sigmoid colon to allow easily for the recognition of colonic folds (arrows)
Fig. 14.7.a,b A collapsed sigmoid loop (white arrow) demonstrates a smooth transition to distal distention (black arrowheads). c Inflation in the complimentary position (black arrow)
Contraction Colon
Fig. 14.8.a,b Colonic contraction in the descending colon (arrow) causes focal wall thickening. c,d Delayed imaging in a complimentary position shows inflation of previously contracted descending colon (arrows)

Fig. 14.9a,b. Annular constricting cancers should not be confused with collapse. Colonic wall thickening and intraluminal irregularity observed in these types of lesion are persistent in complimentary positions. Note the persistent non-distension that is present in both supine (a) and prone (b) images

Fig. 14.9a,b. Annular constricting cancers should not be confused with collapse. Colonic wall thickening and intraluminal irregularity observed in these types of lesion are persistent in complimentary positions. Note the persistent non-distension that is present in both supine (a) and prone (b) images extending into the pericolonic tissues (if invasive), as other large carcinomas.

have previously described, only appearing larger and more bulbous, with a homogenous fatty internal attenuation (Fig. 14.12).

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