0:00

Okay, this next case is a, um, interesting case.

0:03

This is one that was sent by a colleague of mine,

0:07

not in radiology, because at endoscopy they had found a,

0:12

something that looked submucosal, uh,

0:14

near the ileocecal valve, um, at the time of endoscopy,

0:18

and they were not able to biopsy it or they biopsied

0:20

and did not get, uh, tissue back.

0:22

So they asked us to do a CT colonography

0:25

to confirm whether there was a,

0:26

an actual finding in that location.

0:28

And this one was pretty subtle near the ileocecal valve.

0:32

And you can see the ileocecal valve here on the two D images

0:35

or right next door to the iql valve

0:38

and see your typical appearance of that ileocecal valve.

0:42

Again, the, the lips in the right colon.

0:47

But, uh, on the other side of the ileocecal valve,

0:49

you can see there's a little bit of a, what looks like, uh,

0:51

an extrinsic impression upon the colon.

0:54

And if you look on the two D images,

0:57

this is the area of concern.

1:00

And on the soft tissue windows,

1:02

you can see it has soft tissue attenuation

1:05

and it looks like it's actually located on the terminal

1:08

ileal side of the ileocecal valve, not the colonic side.

1:12

So I'm gonna show you on the three D views what the

1:15

view from inside the terminal ileum was.

1:18

And this is the finding there.

1:20

So we confirmed the finding

1:23

and placed it more on the terminal ileal side

1:25

than the colonic side.

1:27

And this, this, um,

1:30

colleague's wife actually was 10

1:33

to surgery for this finding.

1:34

And this was found to be a, uh, a gist tumor,

1:38

gi stromal tumor of the terminal ileum.

1:41

So not everything is an Aden autonomous polyp, and

1:44

because of its size, we still called it AC three lesion.