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Appendiceal Involvement in Crohn's Disease: Gray-Scale Sonography and Color Doppler Flow Features

Tomás Ripollés1, María Jesus Martínez1, Virgilio Morote1 and José Errando1

1 All authors: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain.


Figure 1
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  		Fig. 1 —31-year-old man on routine management for Crohn's disease. At present, patient is asymptomatic. Axial section of right lower quadrant depicts inflamed terminal ileum (IT) with stratification preserved. Thickening of submucosal layer is also present. Behind ileum, thickened appendix (AP) is visible. Cecum (not shown) was normal.

 

Figure 2
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  		Fig. 2A —24-year-old woman with Crohn's disease who presented with abdominal pain and diarrhea. Longitudinal section of right side of abdomen shows diffuse wall thickening of terminal ileum (IT) and cecum (C). Thickened appendix (AP) is visible superior to cecum next to liver.

 

Figure 3
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  		Fig. 2B —24-year-old woman with Crohn's disease who presented with abdominal pain and diarrhea. Transverse sonogram shows thickening of appendix (AP) situated lateral to thickened cecum (C).

 

Figure 4
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  		Fig. 3A —28-year-old man with Crohn's disease who presented with 1-week history of right lower quadrant pain and diarrhea. Sonogram shows marked thickening of terminal ileum (IT) and appendix (AP). Bowel wall stratification is preserved, with echogenic submucosal layer.

 

Figure 5
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  		Fig. 3B —28-year-old man with Crohn's disease who presented with 1-week history of right lower quadrant pain and diarrhea. Color Doppler sonography image shows numerous color pixels scattered throughout bowel wall of both ileum and appendix (flow was considered readily visible). No other intestinal segment was involved sonographically.

 

Figure 6
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  		Fig. 4A —65-year-old woman with no known history of Crohn's disease who presented in emergency setting with right lower quadrant pain. Short-axis sonographic view of right lower quadrant shows thickening of wall of cecum (C), terminal ileum (I), and appendix (A).

 

Figure 7
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  		Fig. 4B —65-year-old woman with no known history of Crohn's disease who presented in emergency setting with right lower quadrant pain. Color Doppler sonography image shows readily visible flow in ileal wall (I). Barely visible color Doppler flow is seen in wall of cecum (C) and appendix (A). No other intestinal segments were involved. Patient was treated conservatively. Diagnosis of Crohn's disease was confirmed at posterior colonoscopy and biopsy.

 

Figure 8
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  		Fig. 5A —Acute appendicitis in 60-year-old man who presented with 3-day history of right lower quadrant pain. Sonography image of short axis of appendix shows noncompressible appendix of 8 mm (AP) and reactive thickening of cecum (CIEGO). Terminal ileum (IT) is slightly thickened.

 

Figure 9
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  		Fig. 5B —Acute appendicitis in 60-year-old man who presented with 3-day history of right lower quadrant pain. Color Doppler sonography image shows hyperemia in wall of appendix (AP). Flow in thickened ileum (IT) is scarce. Surgical exploration revealed perforated appendicitis.

 

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