Objectives

1. Recognition of the normal sonographic appearances of the colonic wall and mesentery

2. Demonstrating and identifying colonic pathology including colonic carcinoma, appendix orifice tumours and intraluminal colonic lesions such as a tubulovillous adenoma (TVA) and lipoma

3. Demonstrating a variety of sonographic appearances of inflammatory colonic disease including inflammatory bowel disease, diverticular disease and active diverticulitis

4. Using ultrasound to confirm computed tomography (CT) appearances represent colonic wall spasm

Background

Colonic ultrasound is currently performed in our institution by gastrointestinal (GI) radiologists with an expertise in small bowel and colonic imaging.

Assessment and interpretation of the colon on CT can be limited by segmental spasm, colitis, complex diverticular disease, residual faecal material and poor insufflation. At our institute we regularly use colonic ultrasound to both diagnose and troubleshoot colonic pathology.

Imaging findings OR Procedure findings

The following findings will be discussed:

1. Normal appearances of the colonic wall layers and mesentery

2. Sonographic appearance of colonic carcinoma with loss of normal colonic wall layering and assessment of mucosal thickness

3. Demonstration of colonic wall depth invasion at varying T stages of disease

4. The appearance of submucosal lesions

5. Sonographic appearances of Crohn’s disease and ulcerative colitis including deep penetrating ulcers and fistulation

6. Uncomplicated diverticular changes

7. Acute diverticulitis and associated complications

8. Spasm versus true colonic pathology

9. Contrast ultrasound assessment of colonic ischaemia

Conclusion

Colonic ultrasound has a wide range of potential clinical uses both to diagnose and trouble-shoot pathology.