0:01

For our fourth case, I'm showing you, uh,

0:04

another case here of a patient with, uh,

0:06

bilateral hip prosthesis.

0:07

So you can see there's a lot of artifacts, streak artifact,

0:10

uh, beam hardening artifact, uh, between these, uh,

0:13

metallic prosthesis in the bilateral hips.

0:16

You wanna widen your windows to be able to see through that.

0:18

You know, just like any other, um, CT image you're looking

0:22

to, um, you have to deal with artifacts that you have, uh,

0:25

at the time of the scan.

0:27

There are metal artifact reduction algorithms on many

0:29

of these scanners that can help, uh, alleviate some

0:32

of the artifact associated with this.

0:34

You can see interestingly, there's some cement, um,

0:36

leakage here medial to the, uh, to the right,

0:39

acetate them as well.

0:40

But when you fly through on the two D images, when we,

0:42

when you scroll through on the two D images,

0:44

you can see our first finding is in the sigmoid colon.

0:49

And this is the reason for the CT

0:51

colonography in this particular case.

0:53

So they, in addition to having an extremely torturous

0:56

sigmoid colon here with a lot of diverticulosis,

1:00

there is a stricture in the sigmoid colon.

1:04

You can see some luminal narrowing here.

1:09

Uh, and parts of it,

1:12

you can see it on the two D images as well.

1:15

This, uh, area of luminal narrowing

1:18

and eccentric wall thickening on soft tissue windows.

1:21

You can really see that there's some bulky soft tissue in

1:23

this suspected, uh,

1:25

malignant stricture in the sigmoid colon.

1:28

And this is what the, um, the,

1:29

the colonoscope could not pass.

1:31

So, you know, usually in these cases the colonoscope will

1:35

get far enough that if there's a stricture

1:37

that's worrisome on endoscopy, they're going

1:39

to still be able to biopsy it.

1:42

But just as importantly, in a patient

1:44

with a suspected colon cancer, is to determine

1:47

what the status of the remainder of the colon is,

1:50

because if there are other masses

1:52

or polyps elsewhere in the colon, they want to be able

1:55

to deal with it at the time of surgery to be able

1:58

to tell whether this patient is just gonna get a partial

2:01

colectomy or if they're gonna need something more than

2:03

just a partial colectomy.

2:04

Are there other lesions to worry about

2:06

in the remainder of the colon?

2:08

So this is where we can be particularly helpful to

2:11

complete the, um, screening of the remainder of the colon,

2:15

uh, in somebody that's, um, likely going to go on to

2:20

a partial colectomy at, of some sort, uh, to get the status

2:24

of the rest of the colon to find if there are any, uh,

2:26

synchronous lesions elsewhere in the colon,

2:28

in the non visualized part of the colon.

2:30

And in this case here, the first finding you can see just

2:32

upstream from the sigmoid mass here

2:36

is a submerged polyp.

2:37

Here. You're not seeing it on the three D views

2:40

because it's submerged with in contrast.

2:42

But you can see on the two D images here

2:44

that similar appearance

2:45

of a pedunculated polyp on a stock arising from the

2:49

proximal sigmoid colon.

2:51

Actually, the stock is on this side here

2:54

and then it's falling independently

2:57

into the, uh, the pool of

2:58

Contrasts on this particular prone image.

3:01

You can take a quick look at the supine image in

3:03

that same location to see how well the sigmoid mass,

3:07

the stricture, uh, opens up.

3:09

And you can see it. It's pretty fixed

3:11

and, uh, narrowed in this location.

3:13

And on the supine images, you can see

3:15

that polyp is obeying the force of gravity

3:18

and it's kind of, uh, lying independently on the supine side

3:23

of that proximal sigmoid colon.

3:24

And we've got a chance to be able

3:26

to see it on the three D view here as well.

3:29

So on the three D image, it kind of looks like

3:32

that lipoma I showed you on the other case, uh, in terms

3:35

of the, uh, shape of it, uh, the, uh,

3:38

the polyp on the stock.

3:39

But in this case, it is not fat attenuation,

3:42

it's soft tissue and attenuation confirmed on the

3:45

soft tissue windows here.

3:47

Remember, contrast coating is okay as long

3:49

as there's not contrast or bubbles of gas within it

3:52

to tell you that you're dealing

3:53

with a stool ball rather than a polyp.

3:56

I think there was one other finding in this particular case,

4:00

and it was actually in the right colon here.

4:02

So you can see there was a, a more proximal lesion in the,

4:06

in the ascending colon here.

4:08

This is located above the ileocecal valve, so

4:11

that would place this in the ascending colon.

4:13

You can see it here on the coronal recons here again

4:16

with a little bit of a contrast coating around it.

4:19

Another pedunculated looking polyp

4:24

with on, on a hostel fold, superior

4:27

to the ilial valve in the right colon

4:30

at the time of resection.

4:32

This was a colon cancer

4:35

and both those polyps were, were confirmed

4:37

to be tubular adenomas.