eMedicine Specialties > Radiology > Gastrointestinal

Crohn Disease: Multimedia

Author: Yung-Hsin Chen, MD, Staff Physician, Department of Radiology, Nassau University Medical Center
Coauthor(s): Dahua Zhou, MD, Staff Physician, Department of Radiology, Nassau University Medical Center; David I Weltman, MD, Consulting Staff, S & D Medical, LLP; Director, Department of Radiology, Southside Hospital
Contributor Information and Disclosures

Updated: Jan 26, 2007

Multimedia

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Media file 1: Crohn disease. Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.

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Crohn disease. Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.

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Media file 2: Crohn disease. Cobblestoning. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates linear longitudinal and transverse ulcerations that create a cobblestone appearance. Also note the relatively greater involvement of the mesenteric side of the terminal ileum and the displacement of the involved loop away from the normal small bowel secondary to mesenteric inflammation and fibrofatty proliferation.

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Crohn disease. Cobblestoning. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates linear longitudinal and transverse ulcerations that create a cobblestone appearance. Also note the relatively greater involvement of the mesenteric side of the terminal ileum and the displacement of the involved loop away from the normal small bowel secondary to mesenteric inflammation and fibrofatty proliferation.

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Media file 3: Crohn disease. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates several narrowing and stricturing, consistent with the string sign. Also note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.

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Crohn disease. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates several narrowing and stricturing, consistent with the string sign. Also note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.

(Enlarge Image)

Media file 4: Crohn disease of the terminal ileum with CT and sonographic correlation. Small-bowel follow-through study demonstrates the string sign in the terminal ileum. Also note pseudodiverticula of the antimesenteric wall of the terminal ileum, secondary to greater distensibility of this less-involved segment of the wall.

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Crohn disease of the terminal ileum with CT and sonographic correlation. Small-bowel follow-through study demonstrates the string sign in the terminal ileum. Also note pseudodiverticula of the antimesenteric wall of the terminal ileum, secondary to greater distensibility of this less-involved segment of the wall.

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Media file 5: Crohn disease of the terminal ileum with CT and sonographic correlation. CT scan of the same patient as in Images 4-8. Note terminal ileal-wall thickening and adjacent mesenteric inflammatory stranding.

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Crohn disease of the terminal ileum with CT and sonographic correlation. CT scan of the same patient as in Images 4-8. Note terminal ileal-wall thickening and adjacent mesenteric inflammatory stranding.

(Enlarge Image)

Media file 6: Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

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Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

(Enlarge Image)

Media file 7: Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

[ CLOSE WINDOW ]

Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

(Enlarge Image)

Media file 8: Crohn disease. Active small-bowel inflammation. CT scan demonstrates small-bowel wall thickening, mesenteric inflammatory stranding, and mesenteric adenopathy.

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Crohn disease. Active small-bowel inflammation. CT scan demonstrates small-bowel wall thickening, mesenteric inflammatory stranding, and mesenteric adenopathy.

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Media file 9: Crohn disease. Mesenteric inflammation. CT scan demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

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Crohn disease. Mesenteric inflammation. CT scan demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

(Enlarge Image)

Media file 10: Crohn disease. Mesenteric inflammation. CT scan in the same patient as in Image 9 demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

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Crohn disease. Mesenteric inflammation. CT scan in the same patient as in Image 9 demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

(Enlarge Image)

Media file 11: Crohn disease. Sonogram of a thickened bowel wall demonstrates the so-called pseudokidney appearance.

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Crohn disease. Sonogram of a thickened bowel wall demonstrates the so-called pseudokidney appearance.

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Media file 12: Crohn disease. Crohn colitis. Double-contrast barium enema study demonstrates marked ulceration, inflammatory changes, and narrowing of the right colon.

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Crohn disease. Crohn colitis. Double-contrast barium enema study demonstrates marked ulceration, inflammatory changes, and narrowing of the right colon.

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Media file 13: Crohn disease. Crohn colitis. CT scan in the same patient as in Image 12 demonstrates marked thickening of the wall of the right colon with inflammatory stranding in the adjacent mesenteric fat.

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Crohn disease. Crohn colitis. CT scan in the same patient as in Image 12 demonstrates marked thickening of the wall of the right colon with inflammatory stranding in the adjacent mesenteric fat.

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Media file 14: Crohn disease. Fibrofatty proliferation. CT scan in a patient with Crohn colitis in the chronic phase demonstrates wall thickening of the right colon, an absence of adjacent mesenteric inflammatory stranding, and a large amount of fatty proliferation around the right colon separating the colon from the remainder of the gut, so-called creeping fat.

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Crohn disease. Fibrofatty proliferation. CT scan in a patient with Crohn colitis in the chronic phase demonstrates wall thickening of the right colon, an absence of adjacent mesenteric inflammatory stranding, and a large amount of fatty proliferation around the right colon separating the colon from the remainder of the gut, so-called creeping fat.

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Media file 15: Crohn disease. Single-contrast barium enema study demonstrates stricturing of the caput cecum, the so-called coned cecum.

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Crohn disease. Single-contrast barium enema study demonstrates stricturing of the caput cecum, the so-called coned cecum.

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Media file 16: Crohn disease. Coned cecum. CT scan in the same patient as in Image 15 demonstrates wall thickening of the cecum with marked narrowing of the lumen.

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Crohn disease. Coned cecum. CT scan in the same patient as in Image 15 demonstrates wall thickening of the cecum with marked narrowing of the lumen.

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Media file 17: Crohn disease. CT with MRI correlation. CT scan in a patient with chronic inactive Crohn disease demonstrates thickening of the wall of the right colon with intramural lucency. This was believed to represent intramural fat deposition.

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Crohn disease. CT with MRI correlation. CT scan in a patient with chronic inactive Crohn disease demonstrates thickening of the wall of the right colon with intramural lucency. This was believed to represent intramural fat deposition.

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Media file 18: Crohn disease. MRI with CT correlation. MRI in the same patient as in Image 17 demonstrates thickening of the wall of the right colon with intramural increased signal on a T1-weighted image. This was believed to represent intramural fat deposition.

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Crohn disease. MRI with CT correlation. MRI in the same patient as in Image 17 demonstrates thickening of the wall of the right colon with intramural increased signal on a T1-weighted image. This was believed to represent intramural fat deposition.

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Media file 19: Crohn disease. Perianal abscesses. CT scan demonstrates multiple fluid, contrast material, and air collections around the anorectum. Note the presence of a rectal tube.

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Crohn disease. Perianal abscesses. CT scan demonstrates multiple fluid, contrast material, and air collections around the anorectum. Note the presence of a rectal tube.

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Media file 20: Crohn disease. Perianal abscesses. CT scan in the same patient as in Image 19 demonstrates multiple fluid, contrast agent, and air collections around the anorectum. Note the presence of a rectal tube.

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Crohn disease. Perianal abscesses. CT scan in the same patient as in Image 19 demonstrates multiple fluid, contrast agent, and air collections around the anorectum. Note the presence of a rectal tube.

(Enlarge Image)

Media file 21: Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in a patient with a prior ileocolectomy demonstrates small-bowel dilatation and wall thickening of the small bowel proximal to the anastomosis.

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Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in a patient with a prior ileocolectomy demonstrates small-bowel dilatation and wall thickening of the small bowel proximal to the anastomosis.

(Enlarge Image)

Media file 22: Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in the same patient as in Image 21 demonstrates small-bowel dilatation and a transition zone at the anastomosis. Note the narrowed segment of bowel at the staple line in the right lower quadrant.

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Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in the same patient as in Image 21 demonstrates small-bowel dilatation and a transition zone at the anastomosis. Note the narrowed segment of bowel at the staple line in the right lower quadrant.

(Enlarge Image)

Media file 23: Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. Small-bowel follow-through in same patient as in Images 21-22 demonstrates mucosal changes of Crohn disease in the distal ileum proximal to the anastomosis and anastomotic stricture.

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Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. Small-bowel follow-through in same patient as in Images 21-22 demonstrates mucosal changes of Crohn disease in the distal ileum proximal to the anastomosis and anastomotic stricture.

(Enlarge Image)

Media file 24: Crohn disease. Enteroenteric fistula. CT scan demonstrates the tract of an enteroenteric fistula.

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Crohn disease. Enteroenteric fistula. CT scan demonstrates the tract of an enteroenteric fistula.

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Media file 25: Crohn disease. Enterocutaneous fistula. CT scan demonstrates enterocutaneous and colocutaneous fistula formation.

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Crohn disease. Enterocutaneous fistula. CT scan demonstrates enterocutaneous and colocutaneous fistula formation.

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Media file 26: Crohn disease. Enterocolic fistula. Double-contrast barium enema study demonstrates multiple fistulous tracts between the terminal ileum and the right colon adjacent to the ileocecal valve, the so-called double-tracking of the ileocecal valve.

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Crohn disease. Enterocolic fistula. Double-contrast barium enema study demonstrates multiple fistulous tracts between the terminal ileum and the right colon adjacent to the ileocecal valve, the so-called double-tracking of the ileocecal valve.

(Enlarge Image)

Media file 27: Crohn disease. Small-bowel follow-through study demonstrates narrowing of the lumen and multiple enteroenteric fistulae, but it fails to show the enterovesical fistula.

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Crohn disease. Small-bowel follow-through study demonstrates narrowing of the lumen and multiple enteroenteric fistulae, but it fails to show the enterovesical fistula.

(Enlarge Image)

Media file 28: Crohn disease. Cystogram in the same patient as in Images 27-30 demonstrates a filling defect and inflammatory changes of the dome of the bladder, but it fails to demonstrate the enterovesical fistula.

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Crohn disease. Cystogram in the same patient as in Images 27-30 demonstrates a filling defect and inflammatory changes of the dome of the bladder, but it fails to demonstrate the enterovesical fistula.

(Enlarge Image)

Media file 29: Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-30 demonstrates an air-filled fistulous tract from the small bowel to the bladder.

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Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-30 demonstrates an air-filled fistulous tract from the small bowel to the bladder.

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Media file 30: Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-29 demonstrates focal thickening of the bladder dome and air in the urinary bladder.

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Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-29 demonstrates focal thickening of the bladder dome and air in the urinary bladder.

More on Crohn Disease

Overview: Crohn Disease

Imaging: Crohn Disease

Follow-up: Crohn Disease

Multimedia: Crohn Disease

References

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References

Del Campo L, Arribas I, Valbuena M. Spiral CT findings in active and remission phases in patients with Crohn disease. J Comput Assist Tomogr. Sep-Oct 2001;25(5):792-7. [Medline].
Dietz DW, Laureti S, Strong SA. Safety and longterm efficacy of strictureplasty in 314 patients with obstructing small bowel Crohn''s disease. J Am Coll Surg. Mar 2001;192(3):330-7; discussion 337-8. [Medline].
Fazio VW, Galandiuk S, Jagelman DG. Strictureplasty in Crohn''s disease. Ann Surg. Nov 1989;210(5):621-5. [Medline].
Gore RM, Balthazar EJ, Ghahremani GG. CT features of ulcerative colitis and Crohn''s disease. AJR Am J Roentgenol. Jul 1996;167(1):3-15. [Medline].
Halpert RD. Requisite: Gastrointestinal Radiology. 2nd ed. 1999: 260-5.
Horton KM, Fishman EK. CT angiography of the GI tract. Gastrointestinal Endoscopy. 2002;55(7 Suppl):S37-41. [Medline].
Karlinger K, Gyorke T, Mako E. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol. Sep 2000;35(3):154-67. [Medline].
Kleer CG, Appelman HD. Surgical pathology of Crohn''s disease. Surg Clin North Am. Feb 2001;81(1):13-30, vii. [Medline].
Koh DM, Miao Y, Chinn RJ. MR imaging evaluation of the activity of Crohn''s disease. AJR Am J Roentgenol. Dec 2001;177(6):1325-32. [Medline].
Laufer L, Hamilton JD. The radiologica differentiation between ulcerative and granulomatous colitis by double contrast radiology. Am J Gastroenterol. 1976;66:259-269.
Levine MS, Rubesin SE, Laufer I. Barium studies. Gastrointest Endosc. Jun 2002;55(7 Suppl):S16-24. [Medline].
Low RN, Sebrechts CP, Politoske DA. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology. Mar 2002;222(3):652-60. [Medline].
Maccioni F, Viscido A, Broglia L. Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom Imaging. May-Jun 2000;25(3):219-28. [Medline].
Madsen SM, Thomsen HS, Schlichting P. Evaluation of treatment response in active Crohn''s disease by low-field magnetic resonance imaging. Abdom Imaging. May-Jun 1999;24(3):232-9. [Medline].
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Mazzeo S, Caramella D, Battolla L. Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution. J Comput Assist Tomogr. Jul-Aug 2001;25(4):612-6. [Medline].
Philpotts LE, Heiken JP, Westcott MA. Colitis: use of CT findings in differential diagnosis. Radiology. Feb 1994;190(2):445-9. [Medline].
Rubesin SE, Scotiniotis I, Birnbaum BA. Radiologic and endoscopic diagnosis of Crohn''s disease. Surg Clin North Am. Feb 2001;81(1):39-70, viii. [Medline].
Sarrazin J, Wilson SR. Manifestations of Crohn disease at US. Radiographics. May 1996;16(3):499-520; discussion 520-1. [Medline].
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Zmora O. Laparoscopy for Crohn disease. Semin Laparosc Surg. Dec 2003;10(4):159-67. [Medline].

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Keywords

Crohn's disease, regional enteritis, inflammatory bowel disease, HLA-DR1 gene, DQw5 gene

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Contributor Information and Disclosures

Author

Yung-Hsin Chen, MD, Staff Physician, Department of Radiology, Nassau University Medical Center
Yung-Hsin Chen, MD is a member of the following medical societies: American Roentgen Ray Society, Massachusetts Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Dahua Zhou, MD, Staff Physician, Department of Radiology, Nassau University Medical Center
Dahua Zhou, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

David I Weltman, MD, Consulting Staff, S & D Medical, LLP; Director, Department of Radiology, Southside Hospital
David I Weltman, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of Program Directors in Radiology, New York County Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

John L Haddad, MD, Clinical Associate Professor, Department of Radiology, Weill Medical College of Cornell University; Director of Body MRI, Department of Radiology, Methodist Hospital in Houston
John L Haddad, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Spencer B Gay, MD, Professor of Radiology, Director of Body Computed Tomography, Department of Radiology, University of Virginia Health Sciences Center
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Gastrointestinal

Crohn Disease: Multimedia

Multimedia

Crohn disease. Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.

Crohn disease. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates several narrowing and stricturing, consistent with the string sign. Also note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.

Crohn disease of the terminal ileum with CT and sonographic correlation. CT scan of the same patient as in Images 4-8. Note terminal ileal-wall thickening and adjacent mesenteric inflammatory stranding.

Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

Crohn disease of the terminal ileum with CT and sonographic correlation. Sonogram in the same patient as in Images 4-8. Note hypoechoic wall thickening, loss of the gut signature, and the hyperechoic line representing the narrowed lumen.

Crohn disease. Active small-bowel inflammation. CT scan demonstrates small-bowel wall thickening, mesenteric inflammatory stranding, and mesenteric adenopathy.

Crohn disease. Mesenteric inflammation. CT scan demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

Crohn disease. Mesenteric inflammation. CT scan in the same patient as in Image 9 demonstrates inflammatory mass in the right lower quadrant associated with thickening of the wall and narrowing of the lumen of the terminal ileum.

Crohn disease. Sonogram of a thickened bowel wall demonstrates the so-called pseudokidney appearance.

Crohn disease. Crohn colitis. Double-contrast barium enema study demonstrates marked ulceration, inflammatory changes, and narrowing of the right colon.

Crohn disease. Crohn colitis. CT scan in the same patient as in Image 12 demonstrates marked thickening of the wall of the right colon with inflammatory stranding in the adjacent mesenteric fat.

Crohn disease. Single-contrast barium enema study demonstrates stricturing of the caput cecum, the so-called coned cecum.

Crohn disease. Coned cecum. CT scan in the same patient as in Image 15 demonstrates wall thickening of the cecum with marked narrowing of the lumen.

Crohn disease. CT with MRI correlation. CT scan in a patient with chronic inactive Crohn disease demonstrates thickening of the wall of the right colon with intramural lucency. This was believed to represent intramural fat deposition.

Crohn disease. MRI with CT correlation. MRI in the same patient as in Image 17 demonstrates thickening of the wall of the right colon with intramural increased signal on a T1-weighted image. This was believed to represent intramural fat deposition.

Crohn disease. Perianal abscesses. CT scan demonstrates multiple fluid, contrast material, and air collections around the anorectum. Note the presence of a rectal tube.

Crohn disease. Perianal abscesses. CT scan in the same patient as in Image 19 demonstrates multiple fluid, contrast agent, and air collections around the anorectum. Note the presence of a rectal tube.

Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in a patient with a prior ileocolectomy demonstrates small-bowel dilatation and wall thickening of the small bowel proximal to the anastomosis.

Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. CT scan in the same patient as in Image 21 demonstrates small-bowel dilatation and a transition zone at the anastomosis. Note the narrowed segment of bowel at the staple line in the right lower quadrant.

Crohn disease. Small-bowel obstruction in a patient with recurrence proximal to an anastomosis. Small-bowel follow-through in same patient as in Images 21-22 demonstrates mucosal changes of Crohn disease in the distal ileum proximal to the anastomosis and anastomotic stricture.

Crohn disease. Enteroenteric fistula. CT scan demonstrates the tract of an enteroenteric fistula.

Crohn disease. Enterocutaneous fistula. CT scan demonstrates enterocutaneous and colocutaneous fistula formation.

Crohn disease. Enterocolic fistula. Double-contrast barium enema study demonstrates multiple fistulous tracts between the terminal ileum and the right colon adjacent to the ileocecal valve, the so-called double-tracking of the ileocecal valve.

Crohn disease. Small-bowel follow-through study demonstrates narrowing of the lumen and multiple enteroenteric fistulae, but it fails to show the enterovesical fistula.

Crohn disease. Cystogram in the same patient as in Images 27-30 demonstrates a filling defect and inflammatory changes of the dome of the bladder, but it fails to demonstrate the enterovesical fistula.

Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-30 demonstrates an air-filled fistulous tract from the small bowel to the bladder.

Crohn disease. Enterovesical fistula. CT in the same patient as in Images 27-29 demonstrates focal thickening of the bladder dome and air in the urinary bladder.

More on Crohn Disease

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor