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(Radiology. 2000;216:712-717.)
© RSNA, 2000

Gastrointestinal Imaging

Segmental Wall Thickening in the Colonic Loop Distal to Colonic Carcinoma at CT: Importance and Histopathologic Correlation1

Hyun-Jung Jang, MD, Hyo K. Lim, MD, Cheol Keun Park, MD, Seong Hyun Kim, MD, Jong Min Park, MD and Yoon-La Choi, MD

1 From the Departments of Radiology (H.J.J., H.K.L., S.H.K., J.M.P.) and Diagnostic Pathology (C.K.P., Y.L.C.), Sungkyunkwan University School of Medicine, Samsung Medical Center, 50, Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea. Received October 14, 1999; revision requested November 6; revision received December 14; accepted December 21. Address correspondence to H.K.L. (e-mail: hklim@smc.samsung.co.kr).

PURPOSE: To determine the importance of the finding of segmental wall thickening in the colonic loop distal to colonic carcinoma at computed tomography (CT) by means of histopathologic correlation.

MATERIALS AND METHODS: Thirteen consecutive patients whose helical CT scans showed segmental wall thickening (>1 cm in maximal width, >5 cm in length) in the colonic loop distal to colonic carcinoma were included. The thickness and length of an involved segment, location, morphologic tumor type, CT patterns of wall thickening, and pericolic changes were evaluated. Surgical pathologic findings in all 13 patients were correlated with CT findings.

RESULTS: The involved segment distal to the colonic carcinoma showed circumferential wall thickening with a preserved wall layer pattern at CT. Pericolic changes of varying degrees were seen in 10 patients. Histopathologic examination revealed submucosal and subserosal edema (n = 6), chronic inflammation and fibrosis (n = 5), or both (n = 1), and no histopathologic alteration (n = 1). The tumors were mostly fungating (n = 11), larger than 5 cm in the greatest dimension (n = 12), located in the ascending colon (n = 10), and extended to pericolic adipose tissue (n = 11).

CONCLUSION: Colonic carcinoma, especially a large fungating type involving the ascending colon with pericolic infiltration, can produce segmental wall thickening in the distal segment at CT, which represents edema or colitis at histopathologic examination.

Index terms: Colitis, 75.26 • Colon, CT, 75.12112, 75.12115 • Colon, diseases, 75.26, 75.321 • Colon, neoplasms, 75.321