0:00

Okay, for our third case, I'm gonna show you

0:03

a few more polypoid findings.

0:05

Um, in this particular case,

0:07

we have multiple findings here in the right colon.

0:10

Um, we're here in the ascending colon here.

0:12

You can see on the two D views here that there are multiple

0:16

findings that look different from the hostile folds.

0:18

And, um, the largest one is located right here.

0:22

I'm showing it to you on the three D image right here.

0:25

And you can see it looks polypoid.

0:28

There may or may not be a stock associated with it,

0:30

but the key finding here is that on the soft tissue windows,

0:35

it does not look like it's soft tissue attenuation.

0:38

It looks like it's similar in attenuation to adjacent fat.

0:41

So that makes this a lipoma.

0:44

There are some tools in our toolbox for some

0:46

of these three D workstations that help you, uh, look

0:49

inside a polyp without necessarily

0:51

looking at the two D views.

0:53

But I find the two D views to, to still be ground truth.

0:55

That's the one I trust the most.

0:57

Some of them have this kind of an X-ray view to it,

1:01

where it'll kind of allow you to look inside the polyp here

1:05

and scroll through the inside of a polyp

1:07

and render the attenuation of the material, uh,

1:10

along the household unit scale here.

1:12

And what you're really looking for here is something

1:14

that's kind of mostly green colored, whereas in this case,

1:17

we're seeing things that are kind of closer to blue

1:20

or purple, representing fat attenuation,

1:23

negative hounsfield unit numbers.

1:24

So this X-ray view this, this spot, NPR view is telling us

1:29

that we're dealing with a lipoma in this case.

1:32

So it doesn't matter what the size of this is, you can try

1:35

to measure it here just for reporting purposes,

1:37

but, um, the size doesn't judge the, um,

1:40

management of a lipoma.

1:42

Uh, generally, um, nothing is necessary in these cases

1:45

unless it happens to be so large

1:47

that it ends up being symptomatic

1:49

or causes some issues with luminal narrowing, for example,

1:54

uh, there are other findings though in the ascending colon

1:57

that don't look clearly fat attenuation.

1:59

And you can see there's other, this one looks like more

2:01

of a bi lobbed looking, um,

2:04

polypoid mass located on an adjacent sal fold

2:08

or further down the SRU fold here.

2:10

And this, uh, is, uh, consistent

2:13

with a soft tissue attenuation polyp.

2:15

You can either measure it as two separate ones

2:17

or one large one,

2:18

but basically it measures greater than

2:20

one centimeter in size.

2:21

So this is something that we already know is gonna be sent

2:24

on to colonoscopy as AC three finding.

2:28

There are a few other findings in this case.

2:32

Right down here you can see there's, there's a third

2:36

polypoid finding in the ascending colon on the two D views.

2:39

You can see that the core of it is soft tissue

2:42

and attenuation, although there is a coating of of contrast

2:46

around that polyp.

2:49

As long as it's on the surface

2:50

and not on the inside of it, that is fine.

2:53

Uh, as if the core of it looks like it's soft tissue,

2:57

then it counts as a polyp. And this

2:58

One looks a little more, um,

3:00

like it could have a little bit of a stock to it.

3:04

So that one's more of a pedunculated polyp and it's size.

3:08

Also, it's probably also big enough to,

3:11

to represent AC three.

3:13

So we have some multiple sizable

3:15

polyps in the ascending colon In this particular case,

3:19

I think there was a fourth polyp in here somewhere.

3:23

Let's take a look and see if we can find it.

3:26

This one may have been easier

3:27

to appreciate on the two D views, there's a little bit

3:30

of thickening and a lot

3:32

of contrast along this halal fold here.

3:34

But one lipoma

3:37

and multiple polyps meeting size criteria for C three.

3:42

Uh, one last thing I'll show you here is

3:44

this is the file view.

3:45

So basically the file view is, uh, analogous

3:48

to gross anatomy specimen of the colon.

3:50

Basically it's a, the colon stretched out, straightened out,

3:54

cut on one side and opened up filet open like a, a canvas.

3:58

And basically you're looking at the full 360 degree, um,

4:02

circumference of the colon.

4:04

And, uh, this is the luminal direction of the colon here.

4:07

The area that's grayed out here is basically your area

4:10

of overlap, so it's a little bit more than 360

4:12

degrees a wraparound.

4:14

And you can see your three SRL folds here

4:17

with a three 10 coli between them.

4:20

And basically you're looking for something

4:21

that looks different from these SRL folds.

4:24

For example, these lesions here and the ascending colon.

4:27

So this is what a mask would look like on the file

4:29

view, multiple of them here.

4:31

And you can just click your mouse on each one of these

4:34

and find them on the three D

4:36

and luminal view here, as well as on the two D images.

4:39

So this is how you can use this.

4:41

And if you page through this,

4:43

you can basically go down the length

4:45

of the entire colon very quickly in just a couple pictures.

4:48

Um, as long as you can read through the image distortion

4:51

that's particularly, uh, prominent at the,

4:54

um, colonic flexors.

4:56

You can see there's other findings in here

4:57

that don't look like al folds either.

4:59

Um, and if you click on them, you can see

5:02

that they actually are Audis, not ins.

5:04

So they're holes in the colon. These are diverticula.

5:08

So these are your typical appearance of the ve diverticulum.

5:11

And they differ in appearance from the house,

5:14

from the polyps in that, uh, when you rotate your camera,

5:18

you can see that it's,

5:19

it's projecting outward rather than inward

5:21

into the lumen of the colon.

5:22

But you can also see

5:23

that oftentimes you'll have an incomplete ring

5:26

of this dark rendering around the, the rim of the finding

5:29

because, uh, you're seeing some mucosal continuity

5:33

with the diverticulum on the other side.

5:35

So they tend to look a little different on the three D views

5:38

and usually are not a, uh, a difficult, um, diagnosis

5:41

to make on the two D images.

5:43

As you can see that they, they look like they're projecting

5:45

out from the wall rather than, uh,

5:47

soft tissue attenuation projecting into the lumen.