Middle mediastinal mass secondary to aneurysm of aorticopulmonary collateral
Joseph Junewick, MD FACR
over 8 years ago
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Joseph Junewick, MD FACR
|Diagnostic Category: Infectious-Inflammatory
|Created: over 6 years ago
|Updated: over 6 years ago
16 year old male with hematochezia and anemia.
History of ulcerative colitis.
CR – Featureless air-filled transverse colon with mural edema (thumbprinting). Note the nearly fused sacroiliac joints.
MR – Coronal FIESTA, SSFSE2 and post-gadolinium LAVA MRI images 2 weeks prior to the radiographic examination show a similar appearance to the transverse colon; the hyperintensity on these sequences is consistent with inflammation.
The etiology of ulcerative colitis is unknown although an interaction between genetic and environmental factors is probable. The incidence is 2–14 per 100,000 persons per year in North America; males are slight more commonly affected than females. Age of onset/diagnosis typically ranges between 15 and 40 years.
About 15%–20% of individuals with ulcerative colitis develop a fulminant form that is characterized by severe symptoms and by inflammation that extends deep beneath the colonic mucosa. Damage to the muscularis propria results in colonic dilatation and loss of haustra. These symptoms are most prominent in nondependent loops of bowel, such as the transverse colon, into which air can rise in a supine patient. Toxic megacolon is a potentially fatal complication seen in less than 5% of patients and is characterized by both non-obstructive dilatation of the colon and systemic toxicity.
Chronic ulcerative colitis is associated with an increased colorectal cancer risk; the risk is correlated with duration and extent of disease. Medical therapy reduces inflammation but does not cure the underlying process; therefore, many patients experience waxing and waning symptoms over time. Surgery cures the intestinal symptoms of ulcerative colitis but gives rise to new risks and changes in lifestyle. Elective surgery is contemplated for those patients with long-standing ulcerative colitis who develop medically intractable symptoms, serious drug-related side effects, dysplasia, or malignancy.
Roggeveen MJ, Tismenetsky M, Shapiro R. Ulcerative Colitis. RadioGraphics (2006); 26:947-951.