Diverticulosis

Diverticular disease is exceedingly common, and is seen as focal outpouchings of the colonic lumen projecting beyond the colonic wall on 2D axial and 2D MPR images. Three-dimensional endoluminal images demonstrate the internal orifices projecting from the colonic lumen (Fig. 14.2 and Fig. 14.3). Occasionally, muscular hypertrophy of diverticulosis can cause colonic wall thickening, but in these segments, we usually observe diverticula interposed throughout the regions of colonic wall thickening. Filling defects can be associated with diverticular disease. The most

Internal Hemorrhoids Endoscopy
Fig. 14.1a,b. Sixty-eight-year-old male with large internal hemorrhoids at endoscopy. a) axial CT image, b) 3D endoluminal image at CT colonography. Note the smoothly marginated and curved filling defects (arrow) that project into the rectal vault, lying adjacent to the rectal tube tip (arrowhead)

Fig. 14.2.a Diverticulosis in a patient with normal CT Colonography. Note the focal outpouchings of the colonic lumen on 2D axial image. b,c 3D endoluminal images showing diverticular (arrows) orifices projecting from the colonic lumen on 3D endoluminal images b

Fig. 14.2.a Diverticulosis in a patient with normal CT Colonography. Note the focal outpouchings of the colonic lumen on 2D axial image. b,c 3D endoluminal images showing diverticular (arrows) orifices projecting from the colonic lumen on 3D endoluminal images a c

Diverticulosis Images

Fig. 14.3a-c. Diverticulosis in a normal patient: a note the focal outpouchings of the colonic diverticula on 2D MPR images (arrows); b,c diverticular orifices projecting from the colonic lumen on 3D endolu-minal images (arrows)

Fig. 14.3a-c. Diverticulosis in a normal patient: a note the focal outpouchings of the colonic diverticula on 2D MPR images (arrows); b,c diverticular orifices projecting from the colonic lumen on 3D endolu-minal images (arrows)

common of these is the stool-containing diverticulum (Fig. 14.4). Stool can be recognized by its heterogeneous internal attenuation characteristics, the presence of intra-lesional air, and pointed edges on 3D endolumi nal views. The fact that a filling defect also projects beyond the colonic wall also indicates the presence of the diverticulum or intramural lesion (as opposed to the neoplastic mucosal lesions). Frequently divertic-

Virtual Colonoscopy Diverticula

Fig. 14.4.a 3D endoluminal image demonstrates a polypoid filling defect. b,c 2D images with soft tissue windows show the filling defect to project beyond the colonic wall into the pericolonic fat (b) and contain barium and air (b,c), indicating the defect is retained stool and barium within a diverticulum

Fig. 14.4.a 3D endoluminal image demonstrates a polypoid filling defect. b,c 2D images with soft tissue windows show the filling defect to project beyond the colonic wall into the pericolonic fat (b) and contain barium and air (b,c), indicating the defect is retained stool and barium within a diverticulum ula will have residual barium from prior radiographic examination. An inverted diverticulum occurs when the diverticular outpouching intussuscepts into the colonic lumen. In such cases, the perienteric fat can be seen within the filling defect.

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