Phlegmon: Vascularized, inflammatory mass that is still perfused and cannot be drained
Abscess: Localized, suppurative, avascular collection of pus amenable to drainage and encompassed by inflamed tissue
CEUS fistulography: Technique in which microbubble contrast agent injected directly into cavity or sinus tract
Inflammatory masses within bowel
Inflammatory polyp: Nonneoplastic intraluminal vascular mass composed of nonepithelialized granulation tissue admixed with inflammatory cells
Intramural abscess: Avascular collection of pus located within bowel wall, shown on grayscale US as asymmetric, hypoechoic mural mass
Contributions of US/CEUS
CEUS can differentiate nature of inflammatory mass as abscess or phlegmon
CEUS offers several advantages to clinical management, all of which lend further support for inclusion of this imaging modality into clinical practice
CEUS is
Noninvasive
Easily repeatable
Free of ionizing radiation
Well tolerated
Flexibility of US/CEUS overall enhanced for this application by addition of
Endovaginal scans in women for accurate assessment of pouch of Douglas and deep loops of bowel
Transperineal scans in both men and women for confirmation of perianal abscess and fistula
CEUS fistulography to potentially replace standard fistulography without requirement of ionizing radiation
CLINICAL IMPLICATIONS
Clinical Importance
Clinical Considerations
CEUS TECHNIQUE
CEUS Protocol Advice
CEUS Fistulography
IMAGING
Perienteric Inflammatory Masses
Intramural/Intraluminal Inflammatory Masses
MANAGEMENT IMPLICATIONS
Clinical Uses of CEUS
SUMMARY
CEUS of Inflammatory Bowel Masses
Selected References
Kucharzik T et al: Intestinal ultrasound and management of small bowel Crohn's disease. Therap Adv Gastroenterol. 11:1756284818771367, 2018
Maconi G et al: EFSUMB Recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall Med. 39(3):304-317, 2018
Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
Pecere S et al: Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD). Dig Liver Dis. 50(8):761-767, 2018
Politis DS et al: Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol. 23(9):1541-1551, 2017
Ripollés T et al: Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol. 82(10):e525-31, 2013
Ripollés T et al: Contrast-enhanced ultrasound (CEUS) in Crohn's disease: technique, image interpretation and clinical applications. Insights Imaging. 2(6):639-652, 2011
Esteban JM et al: Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn's disease. Eur J Gastroenterol Hepatol. 15(3):253-9, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Clinical Implications
Imaging
TERMINOLOGY
Abbreviations
Inflammatory bowel disease (IBD)
Crohn disease (CD)
Definitions
Perienteric inflammatory masses
Phlegmon: Vascularized, inflammatory mass that is still perfused and cannot be drained
Abscess: Localized, suppurative, avascular collection of pus amenable to drainage and encompassed by inflamed tissue
CEUS fistulography: Technique in which microbubble contrast agent injected directly into cavity or sinus tract
Inflammatory masses within bowel
Inflammatory polyp: Nonneoplastic intraluminal vascular mass composed of nonepithelialized granulation tissue admixed with inflammatory cells
Intramural abscess: Avascular collection of pus located within bowel wall, shown on grayscale US as asymmetric, hypoechoic mural mass
Contributions of US/CEUS
CEUS can differentiate nature of inflammatory mass as abscess or phlegmon
CEUS offers several advantages to clinical management, all of which lend further support for inclusion of this imaging modality into clinical practice
CEUS is
Noninvasive
Easily repeatable
Free of ionizing radiation
Well tolerated
Flexibility of US/CEUS overall enhanced for this application by addition of
Endovaginal scans in women for accurate assessment of pouch of Douglas and deep loops of bowel
Transperineal scans in both men and women for confirmation of perianal abscess and fistula
CEUS fistulography to potentially replace standard fistulography without requirement of ionizing radiation
CLINICAL IMPLICATIONS
Clinical Importance
Clinical Considerations
CEUS TECHNIQUE
CEUS Protocol Advice
CEUS Fistulography
IMAGING
Perienteric Inflammatory Masses
Intramural/Intraluminal Inflammatory Masses
MANAGEMENT IMPLICATIONS
Clinical Uses of CEUS
SUMMARY
CEUS of Inflammatory Bowel Masses
Selected References
Kucharzik T et al: Intestinal ultrasound and management of small bowel Crohn's disease. Therap Adv Gastroenterol. 11:1756284818771367, 2018
Maconi G et al: EFSUMB Recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall Med. 39(3):304-317, 2018
Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
Pecere S et al: Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD). Dig Liver Dis. 50(8):761-767, 2018
Politis DS et al: Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol. 23(9):1541-1551, 2017
Ripollés T et al: Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol. 82(10):e525-31, 2013
Ripollés T et al: Contrast-enhanced ultrasound (CEUS) in Crohn's disease: technique, image interpretation and clinical applications. Insights Imaging. 2(6):639-652, 2011
Esteban JM et al: Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn's disease. Eur J Gastroenterol Hepatol. 15(3):253-9, 2003
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