Image Based Question-67997

A 35 year old male presented with recurrent episodes of bloody diarrhea and abdominal pain.Radiological features of the Gastrointestinal tract shows the following.What can be the most propable diagnosis?

A. Crohn’s disease

B. Ulcerative colitis

C. Tuberculosis of colon

D. Carcinoma colon

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Correct Answer » B Explanation

Ans:B.  Ulcerative colitis

Image shows:Single-contrast enema study with total colitis showing mucosal ulcers with a variety of shapes, including collar-button ulcers, in which undermining of the ulcers occurs, and double-tracking ulcers, in which the ulcers are longitudinally orientated.

Imaging Manifestations in Ulcerative Colitis

Acute inflammatory stage

• Spasm and irritability

• Fine mucosal granularity=earliest finding on air-contrast BE

• Spiculated, serrated bowel margins from tiny, multiple ulcerations

• Collar button ulcers-from undermining (not specific for UC)

• Double-tracking=long, longitudinal ulcers in submucosa

• Thumbprinting=from edema of wall

• Pseudopolyps=scattered islands of edematous mucosa in a sea of ulcerated mucosa

• Widening of the presacral space

Subacute stage

• Coarser, more granular mucosa

• Inflammatory polyps= frondlike lesions of inflamed mucosa

Chronic stage

• Shortening of the colon=may be from spasm of longitudinal muscles or from irreversible fibrosis (lead-pipe colon)

• Loss of haustrations on left side of colon

• Postinflammatory polyps=filiform polyps=long worm-like lesions

• Backwash ileitis (5-10%)=wide open ileocecal valve and dilated terminal ileum