0:01

All right, here's another case of colonic

0:03

inflammation with an interesting appearance and

0:06

ultimately interesting way to get to the diagnosis.

0:09

So in this case, you can clearly see

0:10

that the sigmoid colon is abnormal.

0:13

There's a lot of extra fat here.

0:16

You kind of got that creeping fat appearance, but

0:18

it could just be vascular engorgement as well.

0:21

We look at our post-contrast imaging and what we

0:24

see is that there's a lot of involvement. It's not

0:27

severe in terms of wall thickening, but there's

0:29

hyperenhancement throughout much of the colon.

0:31

It's kind of lost its normal fold pattern.

0:33

It has almost that a holstral look.

0:36

And you can see as we go through the transverse

0:38

colon, it's kind of got this hyperenhancement,

0:40

but almost like a tube-like appearance.

0:43

And then we can confirm that on

0:45

our, kind of our T2 sequences.

0:47

It just doesn't have its normal haustrations.

0:49

It's got enhancement.

0:50

It's kind of a diffuse process throughout

0:53

this whole region with some components

0:55

that look like they're somewhat edematous.

0:57

Based on this alone, you know, UC certainly seems

1:00

like a possibility, but Crohn's can have a similar

1:03

appearance, so we're not really sure exactly

1:05

which of the two it is, but in this patient,

1:07

interestingly, we saw a little bit of abnormality

1:10

on the T2 sequence here, and it turns out the

1:12

patient was having some symptoms in the perianal

1:15

region, so we, importantly, we got through there,

1:17

and we saw it looked like there was some fullness

1:19

here, and based on that, plus the symptoms,

1:21

we did recommend that they get a follow-up.

1:24

perianal disease MRI.

1:26

And on the perianal MRI, we can clearly see

1:29

that there's a fistula coming from the anus.

1:31

So here you can see that the anus and we can see a

1:35

tract extending anteriorly from the anus and actually

1:39

extending to the vagina.

1:41

And here we can also see kind of

1:44

some air in there into that tract.

1:46

And so, you know, we're not going to go into detail

1:48

about how to evaluate perianal fistulas for this talk.

1:51

I think that's another course in itself, but this

1:54

is a nice case of showing that the presence of that

1:57

fistula really raised suspicion that this patient

2:00

has Crohn's disease and not ulcerative colitis.

2:04

And in the end, that's what ended up being

2:07

the diagnosis, is Crohn's disease based on

2:10

granulomas found on biopsy of the colon.

2:13

So remember, UC shouldn't have fistulas, but

2:16

fistulas are a marker of Crohn's disease.

2:18

And that was what happened in this

2:21

case to establish the diagnosis.