Tuberculous Colitis
Radiologic-Colonoscopic Correlation
Seong Jin Park1,2,
Joon Koo Han1,
Tae Kyoung Kim1,
Joo Sung Kim3,
Hyun Chae Jung3,
In Sung Song3 and
Byung Ihn Choi1
1
Department of Radiology, Seoul National University College of Medicine, 28,
Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
2
Present address: Department of Diagnostic Radiology, Kyung Hee University
Hospital, 1, Hoeki-dong, Dongdaemun-ku, Seoul, 110-744, Korea.
3
Department of Internal Medicine, Seoul National University College of
Medicine, Seoul, 110-744, Korea.
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Fig. 1A. —16-year-old girl with early-stage tuberculous colitis. Close-up
radiograph of transverse colon shows irregular ulcers with marginal
elevations.
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Fig. 1B. —16-year-old girl with early-stage tuberculous colitis.
Double-contrast barium enema shows terminal ileum with shallow transverse
ulceration and thickened folds (arrows).
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Fig. 1C. —16-year-old girl with early-stage tuberculous colitis. Colonoscopic
image reveals multiple erosions and aphthous ulcers (arrows) on
transverse colon.
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Fig. 2A. —22-year-old woman with advanced tuberculous colitis. Double-contrast
barium enema reveals transverse and circumferential ulcers (arrow) in
ileocecal region and ascending colon.
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Fig. 2B. —22-year-old woman with advanced tuberculous colitis. Single-contrast
barium enema shows thickened circumferential and transverse folds in shortened
and narrowed ascending colon (arrowheads) and terminal ileum
(arrows).
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Fig. 2C. —22-year-old woman with advanced tuberculous colitis. Colonoscopic
image shows transversally oriented ulcerations covered with necrotic slough
and intervening nodular and circumferential elevations of thickened folds.
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Fig. 3A. —21-year-old man with rose-thorn ulcers. Double-contrast barium enema
shows rose-thorn ulcers (arrows) in ascending colon. Note extensive
mucosal irregularities.
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Fig. 3B. —21-year-old man with rose-thorn ulcers. Colonoscopic image shows
shallow ulceration and fold thickening. Colonoscopy has limitations in
revealing deep ulcers with small orifices (rose-thorn ulcers).
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Fig. 4A. —24-year-old woman with inflammatory pseudopolyps and circumferential
ulcers involving ileocecal region and ascending colon. Double-contrast barium
enema shows multiple inflammatory pseudopolyps (arrowheads) with
background of ulcers in the cecum and ascending colon and patulous ileocecal
valve (arrow).
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Fig. 4B. —24-year-old woman with inflammatory pseudopolyps and circumferential
ulcers involving ileocecal region and ascending colon. Colonoscopic image
reveals widespread ulcerations and remnant islands of normal mucosa
(inflammatory pseudopolyps), directly corresponding with A.
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Fig. 5A. —41-year-old woman with discrepancy between double-contrast barium
enema and colonoscopic findings. Double-contrast barium enema shows luminal
narrowing and deformity of ileocecal area and ascending colon without evidence
of active mucosal lesion.
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Fig. 5B. —41-year-old woman with discrepancy between double-contrast barium
enema and colonoscopic findings. Colonoscopic image shows luminal narrowing
and mucosal hyperemia.
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Fig. 5C. —41-year-old woman with discrepancy between double-contrast barium
enema and colonoscopic findings. Colonoscopic image shows areas of active
ulcerations with inflammatory pseudopolyposis (arrows).
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Fig. 6A. —42-year-old woman with patulous ilececal valve. Double-contrast
barium enema shows opened ileocecal valve with cecal deformity (open
arrow). Note inflammatory polyps (solid arrows) seen as filling
defect at ileocecal valve.
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Fig. 6B. —42-year-old woman with patulous ileocecal valve. Similar to findings
on A, colonoscopic image reveals patulous ileocecal valve with polypoid
lesion (arrowheads).
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Fig. 7A. —66-year-old woman with ileocecal deformity with mass formation.
Double-contrast barium enema shows cecal contraction and polypoid mass
(solid arrows) with shouldering. Note deformed ileocecal valve and
deep-penetrating ulcerations (open arrow) in terminal ileum. This
image was used to diagnose inflammatory bowel disease.
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Fig. 7B. —66-year-old woman with ileocecal deformity with mass formation.
Colonoscopic image reveals mulberry-shaped polypoid mass (arrows) in
ileocecal valve area. Because colonoscope could not pass into terminal ileum,
this patient's condition was misdiagnosed as villous tumor on colonoscopy.
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Fig. 8A. —50-year-old man with luminal narrowing of ascending colon.
Double-contrast barium enema reveals distal and proximal loops of ascending
colon to stenosis (arrowheads). Double-contrast barium enema can
reveal ulcerations and deformities of cecum and ascending colon proximal to
stenotic segment.
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Fig. 8B. —50-year-old man with luminal narrowing of ascending colon.
Colonoscopic image shows that colonoscope was unable to pass stenotic segment
(arrow).
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Fig. 9A. —69-year-old woman with pouch formation in ascending colon and cecum.
Double-contrast barium enema reveals pouches (arrows) resulting from
postinflammatory fibrosis in ascending colon and cecal deformity.
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Fig. 9B. —69-year-old woman with pouch formation in ascending colon and cecum.
Colonoscopic image shows opening of pouches (arrows).
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