Crohn’s Disease - RADIOGRAPHY
Posted by Alex
Radiographic examination should begin with a supine and upright view of the abdomen. Associated findings of nephrolithiasis, cholelithiasis, or arthritis of the spine or sacroiliac joints may be identified. Intestinal dilatation or air-fluid levels suggesting obstruction preclude aggressive barium studies until the patient’s clinical condition is stabilized. In colitis, a plain view of the abdomen often demonstrates a tubular, ahaustral segment of colon in the presence of distal UC with fecal matter proximal to diseased mucosa. Intestinal edema, ulceration, or thumb-printing may give a gross estimate of disease activity. Air-contrast barium studies of the colon reveal diffuse, contiguous granularity, superficial ulceration, and absent haustration in active UC. Pseudopolyps or a tubular-appearing “lead pipe” colon may be found in chronic UC. Focal, asymmetric ulceration with linear or fissuring ulcers, the presence of fistulas, rectal sparing, or a diseased terminal ileum with reflux of the barium define the radiographic extent and severity of colonic CD. A small bowel follow-through or enteroclysis (small bowel enema) demonstrates the extent of small intestinal involvement in CD and is normal in the absence of backwash ileitis in UC.