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 ADVANCED IMAGING CENTER PHYSICIAN NEWS |
 October 21, 2002 |
INTERESTING CASE PRESENTATION:
INTUSSUSCEPTION -- CT APPEARANCE
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ADVANCED IMAGING CENTER PHYSICIAN NEWS |
October 21, 2002 |
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CLINICAL PRESENTATION: This 53-year-old female presented to her primary care physician for abdominal pain mainly in the left lower quadrant (LLQ). The patient was referred to AIC for a helical CT of the abdomen.
CT FINDINGS: The study was performed on AIC’s helical multislice CT (MSCT) scanner. Three series including a precontrast, an immediate postcontrast and a delayed series were obtained. The two images on the left are axial immediate postcontrast (arterial-venous phase) images showing a “mass” in the LLQ (arrows). It contains central fat (interposed pericolonic fat as shown in the right diagram), oral contrast within the lumen, and enhancing mucosa. It has a “psudokidney”, “doughnut” or “target” appearance.
EXPLAIN THE REASON FOR THE CT APPEARANCE: Intussusception is involution of a loop of bowel (intussusceptum) upon itself or adjacent bowel loop (intussuscipiens). This creates, in cross section, two layers of bowel wall interposed by peri-intestinal fat on each side with central bowel lumen (diagram on the right). Three concentric rings are seen due to lumen+wall of intussusceptum (central ring), crescent of mesenteric fat (middle ring), and returning intussusceptum+intussuscipiens (outer ring).
MOST COMMON LOCATIONS FOR INTUSSUSCEPTION: Ilio-colonic in children and ilioileal in adults.
ETIOLOGY OF INTUSSUSCEPTION: Almost 94% occur in children with an idiopathic etiology in 95% of them and 5% with a lead point. In adults, there is a lead point in 80% of cases with 20% of idiopathic etiology.
TREATMENT OF INTUSSUSCEPTION: Intussusception in children is usually reduced using a Barium or air enema. If there is a leading cause such as a tumor, then surgery is necessary.
For more information, please call me personally at (661) 949-8111.
Ray Hashemi, MD, PhD
Director