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Extracolonic Findings Identified in Asymptomatic Adults at Screening CT Colonography

Perry J. Pickhardt1,2 and Andrew J. Taylor1

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 20814.


Figure 1
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  		Fig. 1A —Biliary calculi in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 58-year-old man shows cholelithiasis with two large gallstones showing rim calcification (arrowheads). Note also gas within one calculus (arrow).

 

Figure 2
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  		Fig. 1B —Biliary calculi in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT images in 68-year-old woman show cholelithiasis (arrowhead, B) and choledocholithiasis (arrow, C). There was mild biliary ductal dilatation and there were additional common duct stones (not shown) but no clinical symptoms or elevated bilirubin.

 

Figure 3
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  		Fig. 1C —Biliary calculi in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT images in 68-year-old woman show cholelithiasis (arrowhead, B) and choledocholithiasis (arrow, C). There was mild biliary ductal dilatation and there were additional common duct stones (not shown) but no clinical symptoms or elevated bilirubin.

 

Figure 4
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  		Fig. 2 —Unenhanced transverse CT image in asymptomatic 50-year-old man undergoing CT colonography screening shows a 5-mm left lower pole renal calculus (arrow).

 

Figure 5
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  		Fig. 3 —Unenhanced transverse CT image in asymptomatic 51-year-old man undergoing CT colonography screening shows multiple subcentimeter noncalcified pulmonary nodules. Patient has no history of malignancy and is currently undergoing CT surveillance to assess stability of these lesions.

 

Figure 6
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  		Fig. 4 —Unenhanced transverse CT image in asymptomatic 58-year-old man undergoing routine colorectal screening shows unsuspected 5.4-cm abdominal aortic aneurysm (arrowhead) with intimal calcification and subtle crescentic mural thrombus. Patient subsequently underwent successful surgical repair of aneurysm.

 

Figure 7
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  		Fig. 5A —Benign cystic adnexal lesions in asymptomatic women undergoing routine colorectal screening. Unenhanced transverse CT image in 59-year-old woman shows large unilocular cyst (C) in right adnexal region and adjacent solid lesion (F), which represents pedunculated broad ligament fibroid. U = uterus.

 

Figure 8
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  		Fig. 5B —Benign cystic adnexal lesions in asymptomatic women undergoing routine colorectal screening. Unenhanced transverse CT image in 68-year-old woman shows left adnexal cystic lesion (arrow) that was complex at subsequent pelvic sonography (not shown) and proved to be benign fibroadenoma after surgical resection.

 

Figure 9
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  		Fig. 6 —Unenhanced transverse CT image in asymptomatic 68-year-old man undergoing CT colonography screening shows minimally complicated left renal cyst with thin focal rim calcification (arrow). Lesion was unchanged from CT performed more than 5 years earlier for prostate cancer staging (not shown). Note also cholelithiasis (arrowhead).

 

Figure 10
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  		Fig. 7 —Unenhanced transverse CT image in asymptomatic 57-year-old woman undergoing CT colonography screening shows subtle 5-cm hepatic lesion (arrowheads) not compatible with simple cyst. Lesion was confirmed to represent cavernous hemangioma on dynamic IV contrast-enhanced CT (not shown).

 

Figure 11
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  		Fig. 8A —Unsuspected extracolonic malignancy in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 56-year-old woman shows complex solid and cystic left adnexal mass that proved to be papillary serous adenocarcinoma of ovary. Note mural soft-tissue nodule (arrowhead).

 

Figure 12
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  		Fig. 8B —Unsuspected extracolonic malignancy in asymptomatic adults undergoing routine colorectal screening. Unenhanced coronal CT image in 52-year-old man shows solid exophytic mass extending off upper pole of left kidney (arrowheads), which proved to be renal cell carcinoma. This case reinforces utility of multiplanar evaluation because this lesion may be difficult to detect on transverse images alone.

 

Figure 13
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  		Fig. 8C —Unsuspected extracolonic malignancy in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 51-year-old woman shows confluent retroperitoneal lymphadenopathy (asterisk), which was subsequently diagnosed as non-Hodgkin's lymphoma by CT-guided biopsy.

 

Figure 14
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  		Fig. 8D —Unsuspected extracolonic malignancy in asymptomatic adults undergoing routine colorectal screening. Unenhanced coronal CT image in 63-year-old man shows spiculated left lower lobe pulmonary nodule (arrow), which was subsequently diagnosed as non-small cell lung carcinoma by CT-guided biopsy. Patient underwent successful surgical excision of this T1 lesion.

 

Figure 15
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  		Fig. 9A —Congenital variants in asymptomatic adults undergoing routine colorectal screening. Unenhanced coronal CT image in 42-year-old man with family history of colon cancer shows malrotation (nonrotation) with air-filled colon predominately occupying left abdomen and small bowel predominately on right. Absence of duodenal sweep and reversal of normal superior mesenteric artery-superior mesenteric vein relationship were evident on other images (not shown). C = cecum.

 

Figure 16
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  		Fig. 9B —Congenital variants in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 51-year-old man shows multiple small spleens (short arrows), abrupt shortening of pancreas (long arrow), and preduodenal portal vein (arrowhead), all compatible with heterotaxy (polysplenia). ICV interruption was not present but borderline cardiomegaly was suggested on CT scout (not shown); cardiac evaluation has not yet been pursued.

 

Figure 17
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  		Fig. 9C —Congenital variants in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 55-year-old man shows unsuspected horseshoe kidney (arrows). Small calculus was present in left upper pole moiety (not shown).

 

Figure 18
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  		Fig. 9D —Congenital variants in asymptomatic adults undergoing routine colorectal screening. Unenhanced transverse CT image in 54-year-old man shows inferior vena cava duplication (arrows).

 

Figure 19
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  		Fig. 10A —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 59-year-old woman shows an exophytic lesion extending off left lower pole kidney (arrow), diagnostic of angiomyolipoma.

 

Figure 20
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  		Fig. 10B —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 74-year-old man shows right adrenal lesion containing macroscopic fat (arrow), diagnostic of myelolipoma.

 

Figure 21
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  		Fig. 10C —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 54-year-old man shows bilateral low-attenuation adrenal lesions (arrowheads). Attenuation measured less than 10 H for both lesions, diagnostic of nonhyperfunctioning adenomas.

 

Figure 22
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  		Fig. 10D —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 54-year-old woman shows ovoid lipoma (arrow) within proximal jejunum. Note also subtle cholelithiasis within distended gallbladder. Subsequently, 5-cm jejunal lipoma was resected via enterotomy during open cholecystectomy.

 

Figure 23
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  		Fig. 10E —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 42-year-old woman with family history of colon cancer shows pelvic mass (arrows) containing fat, soft tissue, and calcifications, diagnostic of ovarian teratoma.

 

Figure 24
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  		Fig. 10F —Fat- or lipid-containing lesions in asymptomatic adults that allow specific diagnosis on CT colonography. Unenhanced transverse CT image in 57-year-old woman shows large fat-containing mass (asterisk) centrally within uterus, which was confirmed to represent lipoleiomyoma after surgical resection.

 

Figure 25
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  		Fig. 11A —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image (A) in 65-year-old woman shows small, subcentimeter soft-tissue lesion involving distal ileum (arrow). Volume-rendered 3D endoluminal image from CT colonography (B) and digital photograph from optical colonoscopy (C) show same lesion, which proved to be carcinoid tumor. We do not routinely perform 3D fly-through of distal ileum at CT colonography.

 

Figure 26
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  		Fig. 11B —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image (A) in 65-year-old woman shows small, subcentimeter soft-tissue lesion involving distal ileum (arrow). Volume-rendered 3D endoluminal image from CT colonography (B) and digital photograph from optical colonoscopy (C) show same lesion, which proved to be carcinoid tumor. We do not routinely perform 3D fly-through of distal ileum at CT colonography.

 

Figure 27
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  		Fig. 11C —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image (A) in 65-year-old woman shows small, subcentimeter soft-tissue lesion involving distal ileum (arrow). Volume-rendered 3D endoluminal image from CT colonography (B) and digital photograph from optical colonoscopy (C) show same lesion, which proved to be carcinoid tumor. We do not routinely perform 3D fly-through of distal ileum at CT colonography.

 

Figure 28
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  		Fig. 11D —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image with polyp window setting (D) and volume-rendered 3D endoluminal image (E) in 55-year-old woman show incidental polypoid mass (arrowhead, D) in distal jejunum. Lesion proved to be jejunal hamartoma after surgical recision.

 

Figure 29
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  		Fig. 11E —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image with polyp window setting (D) and volume-rendered 3D endoluminal image (E) in 55-year-old woman show incidental polypoid mass (arrowhead, D) in distal jejunum. Lesion proved to be jejunal hamartoma after surgical recision.

 

Figure 30
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  		Fig. 11F —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced curved reformatted sagittal CT image in 63-year-old man shows grossly dilated appendix (asterisk) with subtle mural calcification (arrowheads), consistent with mucocele. Proximal appendix near base appears normal (arrow). Gas-filled sigmoid colon (S) abuts cecum (C). Mucinous adenoma of appendix was confirmed after surgical recision.

 

Figure 31
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  		Fig. 11G —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image in 67-year-old woman shows cystic lesion adjacent to distal esophagus (arrow). Comparison with chest CT performed 2 years earlier showed lesion was stable and is believed to most likely represent foregut duplication cyst.

 

Figure 32
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  		Fig. 11H —Noncolorectal gastrointestinal lesions seen in asymptomatic adults undergoing routine screening. Unenhanced transverse CT image in 58-year-old woman shows densely calcified gastric mass (arrow), which proved to be leiomyoma after surgical wedge resection.

 

Figure 33
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  		Fig. 12 —Unenhanced sagittal CT image in asymptomatic 56-year-old woman undergoing CT colonography screening shows unsuspected spondylolisthesis and degenerative changes at the L5-S1 level (arrow), resulting from bilateral L5 pars defects (spondylolysis). These defects can be seen better on other images.

 

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