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Adenomatous Polyp Obscured by Small-Caliber Rectal Catheter at Low-Dose CT Colonography: A Rare Diagnostic Pitfall

Perry J. Pickhardt1,2 and J. Richard Choi2,3

1 Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252.
2 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD.
3 Department of Radiology, Walter Reed Army Medical Center, Washington, DC.



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  		Fig. 1. —Apparatus for colonic distention with room air. Small flexible catheter is connected to air-bulb insufflator by enema tubing. This device allows safe, inexpensive, and effective colonic distention in time-efficient manner.

 


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  		Fig. 2A. —66-year-old asymptomatic woman referred for routine colorectal cancer screening. Low-dose CT colonography (CTC) was performed immediately before optical colonoscopy (OC). Digital photograph from OC shows 10-mm lobulated sessile polyp within rectum. Note calibrated probe adjacent to polyp, which permits more accurate size measurement than forceps estimation at open biopsy. Polyp was confirmed as tubulovillous adenoma at histologic examination.

 


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  		Fig. 2B. —66-year-old asymptomatic woman referred for routine colorectal cancer screening. Low-dose CT colonography (CTC) was performed immediately before optical colonoscopy (OC). Three-dimensional endoluminal view from prone CTC data set simulating endoscopic retroflexed view of anorectum (note arrowhead at anal verge) shows polypoid lesion that is largely obscured by rectal catheter (arrows). Image was obtained from retrospective manual 3D navigation to optimize polyp visualization. Lesion was less apparent on navigation along automated center line.

 


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  		Fig. 2C. —66-year-old asymptomatic woman referred for routine colorectal cancer screening. Low-dose CT colonography (CTC) was performed immediately before optical colonoscopy (OC). Three-dimensional endoluminal view from supine CTC data set shows polyp beneath catheter (arrow). Note catheter tip (arrowhead). As in B, vantage has been optimized by manual 3D navigation. Surface irregularity in B and C is related to low-dose technique.

 


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  		Fig. 2D. —66-year-old asymptomatic woman referred for routine colorectal cancer screening. Low-dose CT colonography (CTC) was performed immediately before optical colonoscopy (OC). Two-dimensional sagittal supine image viewed using polyp window settings shows catheter contacting polyp along anterior rectal wall (arrow). Lesion was more subtle on 2D axial images (not shown). Note catheter tip (arrowhead). Less advanced placement of catheter may have allowed it to fall away from polyp with change in positioning and permitted detection.

 

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