Atlas of Gastrointestinal Imaging Figure 2.1.4 Colonic perforation from toxic ulcerative colitis

Dr. Perry Pickhardt
Aug 26, 2007
FIGURE 2.1.4 Colonic perforation from toxic ulcerative colitis. Supine radiograph (A) from a patient with severe abdominal pain and leukocytosis shows colonic fold thickening ("thumbprinting") and massive pneumoperitoneum (Rigler's sign) related to perforation from toxic colitis. This was the initial presentation of UC in this patient. Contrast-enhanced CT image (B) from another patient with colonic perforation from UC shows massive intraperitoneal air (asterisks) anterior to an inflamed transverse colon. Note the prominent inflammatory pseudopolyp (arrowhead).
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Representative axial images of mild, moderate, and severe emphysema at baseline low-dose CT (LDCT). Participants were categorized as having no emphysema or mild, moderate, or severe emphysema. When present, emphysema was mild if no distinct regions of reduced attenuation were visible on the CT scan, but vascular splaying indicates parenchymal expansion, or if only occasional discrete low-attenuation regions were observed. Moderate emphysema was defined by the presence of identifiable low-attenuation regions affecting less than half of the lung parenchyma, whereas severe emphysema was defined by the presence of identifiable low-attenuation regions that involved more than half of the lung parenchyma. A scoring system from 0 to 3 was applied, corresponding to none, mild, moderate, and severe emphysema, respectively. Yellow circle indicates the extent of emphysema. (A) A 67-year-old man with mild emphysema at baseline LDCT in 2002. Baseline LDCT scan shows vascular splaying, suggesting parenchymal expansion due to emphysema and occasional discrete low-attenuation regions. The participant ultimately died of cardiovascular disease 15.4 years (184.2 months) later. (B) A 69-year-old man with moderate emphysema at baseline LDCT in 2007. The participant died of cardiovascular disease 1.8 years (21.9 months) later. Identifiable low-attenuation regions affected less than half of the lung parenchyma. (C) An 85-year-old woman with severe emphysema at baseline LDCT in 2006. After 5.5 years (65.5 months) of follow-up, the participant died due to chronic obstructive pulmonary disease–related causes. Identifiable low-attenuation regions involved more than half of the lung parenchyma.
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