0:00

Okay, so for our next case, we're, I'm showing you a case

0:03

where there's multiple findings here.

0:06

I'm gonna start on the two D views.

0:07

'cause usually things that look highly suspicious from a

0:10

for malignancy are better appreciated on two

0:12

Ds than on three Ds.

0:13

Three Ds are great for polyps, but, um, masses are,

0:17

and especially anular constricting

0:19

masses are better appreciated.

0:20

On the two D views in this case,

0:21

you can see there's multiple areas

0:23

of thickening in the sigmoid colon.

0:25

Very similar in appearance to some

0:27

of the other cases I showed you, uh, especially in terms

0:30

of multiplicity because there's also areas

0:32

of thickening in the, in the right colon, for example.

0:35

Here you can see what this looks like on the three D views.

0:39

The end luminal views look very, uh, abnormal

0:41

and thickened, even though the, um, lumen is not quite

0:44

as distended there.

0:46

It's on the other side of this fold here.

0:50

So we've got multiple areas of colonic wall thickening.

0:52

They all look very suspicious for a cancer,

0:56

but we've got one better diagnosis

0:59

that we can make here than, than

1:02

multifocal synchronous colon cancers.

1:05

In this particular case, the key is

1:07

knowing the clinical history.

1:09

The, um, the relevant clinical history is

1:11

that this patient had cervical cancer.

1:14

And if you look on the, on the sagittal re conci here,

1:17

you can see where the, the uterus is and where the cecum is.

1:21

We're not getting the greatest definition without, uh,

1:24

IV contrast on board,

1:25

but you can see that a lot of the soft tissue attenuation

1:27

extends from the region of the cervix to the adjacent colon.

1:33

And then that some of these other areas in the right colon

1:35

could potentially be related to, um,

1:39

peritoneal implants in the pericolic gutter,

1:42

and somebody that likely has a, um,

1:45

peritoneal carcinomatosis related to cervical cancer.

1:48

So in this case, what we're seeing is secondary involvement

1:51

of the colon, either serosal implants

1:55

or direct invasion of the adjacent sigmoid colon

1:58

and somebody with stage four cervical cancer.

2:01

And this was confirmed at surgery.