Colonic Adenocarcinoma

Kathleen S Lee, MD
Marla Polger, MD

March 31, 1995

Presentation

Imaging Findings

An anteroposterior (AP) plain radiograph of the chest indicates moderate left pleural effusion (arrow) and patchy consolidation at the left lung base (arrow). An abnormal gas collection projects over the cardiac apex (arrow).

On supine and upright KUB (kidney, ureter and bladder) images, surgical skin staples and a clip in the left upper quadrant of the abdomen indicate recent abdominal surgery. The small and large bowel are distended with multiple gas-fluid levels (arrows). An abnormal gas pattern is visible in the left upper quadrant of the abdomen with two gas-fluid levels (arrows). One level could represent the gastric fundus, but the second gas-fluid level is abnormal. It is unlikely bowel as it is separate from the transverse colon and is located superior to small bowel loops. This abnormal gas collection could be intrathoracic (empyema or lung abscess) or intraabdominal (subphrenic abscess). The gas distribution is atypical for pneumoperitoneum.

Abdominal computed tomography (CT) with intravenous contrast enhancement indicates a large 11x11cm left upper quadrant (LUQ) subphrenic fluid collection with a gas-fluid level (arrows). This fluid collection indents the superior aspect of the spleen and may involve the spleen (labelled images). Anteriorly, there is gaseous communication between this collection and the splenic flexure (arrow). The splenic flexure wall is circumferentially thickened and somewhat nodular (arrows). Small bowel and colonic dilation (image with arrows)(another slice with arrows)(a third slice with arrows) to the level of the diseased splenic flexure with decompression of the descending colon (arrow) suggests colonic obstruction. A surgical clip abuts the splenic flexure (arrow). Multiple enlarged, low-attenuation lymph nodes (arrows) are visible in the left upper quadrant pericolonic region and in the retroperitoneum extending several centimeters below the aortic bifurcation.

Several renal cysts (arrows) and cholelithiasis (arrow) are unlikely related to the acute process. The other abdominal visceral organs have a normal appearance.

Diagnosis

Discussion

Less likely alternatives include lymphoma or colonic diverticulitis. Colonic lymphoma usually arises in the cecum or ascending colon. Diverticulitis usually arises in the sigmoid colon and is not associated with such extensive lymph node enlargement as in this case. Tuberculosis can cause necrotic lymph nodes, but when it occurs in the colon, it is usually the cecum that is involved.

References

2. Gore RM, Levine MS, Laufer I. Textbook of gastrointestinal radiology. Philadelphia: WB Saunders 1994.

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