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CT of Cecal Volvulus

Unraveling the Image

Carolyn J. Moore1, Frank M. Corl1 and Elliot K. Fishman1,2

1 Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
2 Department of Radiology, Johns Hopkins Hospital, 601 N. Caroline St., Baltimore, MD 21287.



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  		Fig. 1. —Drawing shows loop-type cecal volvulus. Cecum may twist either clockwise or counterclockwise and then inverts upward. Twisted terminal ileum is seen tangled with cecum. Lower left illustration shows point of torsion as it would appear on axial CT images. Lg. = large, Sm. = small.

 


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  		Fig. 2A. —Two patients with cecal volvulus located in the left upper quadrant. Topogram in 33-year-old woman reveals markedly air-distended cecum in shape of coffee bean.

 


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  		Fig. 2B. —Two patients with cecal volvulus located in the left upper quadrant. Axial CT image of same patient as A shows inferiorly placed transverse colon separate from the cecal volvulus.

 


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  		Fig. 2C. —Two patients with cecal volvulus located in the left upper quadrant. Axial CT image shows "coffee bean" sign in 55-year-old man.

 


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  		Fig. 3A. —Cecal volvulus in 81-year-old woman. Axial CT scan of air-distended cecum in left upper quadrant with decompressed descending colon (arrow).

 


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  		Fig. 3B. —Cecal volvulus in 81-year-old woman. Axial CT scan obtained inferior to region in A reveals that transverse colon is separate from cecal volvulus.

 


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  		Fig. 4A. —Axial CT images of 33-year-old woman seen in Figures. 2A and 2B. Progressive tapering of efferent and afferent loops terminating at site of torsion in "bird beak" equivalent (C, arrowhead).

 


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  		Fig. 4B. —Axial CT images of 33-year-old woman seen in Figures. 2A and 2B. Progressive tapering of efferent and afferent loops terminating at site of torsion in "bird beak" equivalent (C, arrowhead).

 


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  		Fig. 4C. —Axial CT images of 33-year-old woman seen in Figures. 2A and 2B. Progressive tapering of efferent and afferent loops terminating at site of torsion in "bird beak" equivalent (C, arrowhead).

 


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  		Fig. 5A. —Axial CT scan shows cecal volvulus in 57-year-old man. "Whirl sign" is composed of spiraled loops of collapsed cecum, distal ileum, and enhancing engorged vessels. Soft-tissue center corresponds to source of volvulus (long arrow). Note radiating mesenteric fat (short arrow).

 


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  		Fig. 5B. —Axial CT scan shows cecal volvulus in 57-year-old man. Schematic diagram of whirl sign. Lg. = large, Sm. = small.

 


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  		Fig. 6A. —66-year-old woman with cecal torsion. Three-dimensional reconstructions use volume rendering to define presence of cecal volvulus. Volume display of entire data set has potential advantages over review of multiple axial images by defining entire colon and areas of transition. Image rendering simulates a single-contrast barium study.

 


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  		Fig. 6B. —66-year-old woman with cecal torsion. Three-dimensional reconstructions use volume rendering to define presence of cecal volvulus. Volume display of entire data set has potential advantages over review of multiple axial images by defining entire colon and areas of transition. Image rendering simulates a double-contrast barium study.

 


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  		Fig. 6C. —66-year-old woman with cecal torsion. Three-dimensional reconstructions use volume rendering to define presence of cecal volvulus. Volume display of entire data set has potential advantages over review of multiple axial images by defining entire colon and areas of transition. In this sagittal reconstruction, adjacent bowel loops can be distinguished and site of volvulus can be defined.

 

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