Learning objectives
To review the imaging findings of acute diverticulitis;
To identify the possible complications of acute diverticulitis;
To recognize the range of pathologies that can mimic acute diverticulitis and to identify ancillary imaging findings that allow their diagnosis.
Background
Colonic diverticular disease (diverticulosis) is frequent in Western nations,
affecting more frequently the elderly.
However,
bad dietary habits adopted by young people,
low in fibers,
are responsible for an increase in the prevalence of diverticulosis in those younger than 40.
The great majority of colonic diverticula are acquired – pseudodiverticula ( Fig. 1 ),
representing small protrusions of colonic mucosa and submucosa through the muscularis propria,
occurring at the point where the vessels pierce the muscularis,
between the mesenteric and antimesenteric teniae.
These acquired diverticula...
Imaging findings OR Procedure details
DIVERTICULITIS
The best imaging modality for diverticulitis assessment is undoubtedly CT,
especially for its ability to diagnose diverticulitis complications (e.g.: abscesses,
perforation).
Nevertheless,
in our daily practice,
when there is not a clear suspicion of diverticulitis,
the diagnostic algorithm of lower left abdominal pain generally starts with US abdominal and pelvic examination.
US has similar sensitivity and specificity to CT in cases of uncomplicated diverticulitis.
It has some advantages relatively to CT including the lower cost,
the wider availability and the absence of ionizing radiation....
Conclusion
Acute abdominal pain is one of the leading causes of emergency department visits,
with acute colonic diverticulitis being one of the most frequent diagnoses.
Despite common,
diagnosing diverticulitis is not as easy as it may look,
as several other pathologies have similar clinical presentations.
Imaging studies,
with US and CT as the main resources,
are generally ordered.
In this way,
it is absolutely essential that every radiologist knows the possible imaging findings that diverticulitis and its closest differential diagnoses may present,
allowing to attain the...
References
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Almeida,
AT et al.
Epiploic Appendagitis: An Entity Frequently Unknown to Clinicians—Diagnostic Imaging,
Pitfalls,
and Look-Alikes.
American Journal of Radiology,
November,
2009; 193:1243-1251.
2.
Balthazar,
EJ et al.
Limitations in the CT diagnosis of acute diverticulitis: comparison of CT,
contrast enema,
and pathologic findings in 16 patients.
American Journal of Radiology,
February,
1990; 154:281-5.
3.
Balthazar,
EJ et al.
Ischemic Colitis: CT Evaluation of 54 Cases.
Radiology,
May,
1999; 211:2 381-388.
4.
DeStigter,
KK et al.
Imaging Update: Acute Colonic Diverticulitis.
Clinics in Colon...