Ileal Diverticulitis

Axial CT image shows an ileal diverticulum (arrow) with surrounding inflammation (arrowheads). Thin arrow = normal appendix.

Sagittal CT image again confirms the presence of an inflamed ileal diverticulum. Note a normal cecum.

Facts

• Two percents of population have small-bowel diverticula
• These can be congenital or acquired.
• Acquired diverticula are common in jejunum and terminal ileum. They are mucosal herniation along the mesenteric border.
• About 6-10% of patients with small-bowel diverticula develop complications (-itis, hemorrhage, obstruction, intussusception)

Imaging

• CT can show inflammatory change around the diverticulum with mural thickening of the adjacent bowel loops. The appendix and cecum are normal.

Reference:

Gourtsoyiannis NC. Radiologic Imaging of the Small Intestine, 2002.

Kaposi's Sarcoma

Axial CT image shows perihilar peribronchovascular thickening (arrows) and several small ill-defined nodules in the peribronchovascular distribution.

Axial CT image shows patchy groundglass opacities and consolidation in the right middle and lower lobes.

Facts

• Multicentric neoplasm occuring in three distinct clinical settings: classic (middle-aged adults or elderly men with indolent course), endemic (native populations of equatorial Africans) and disseminated forms (AIDS and immunosuppressed recipients of organ transplants)
• Associated with human herpesvirus type 8
• Cutaneous manifestations usually precede visceral disease
• Respiratory disease is a late manifestation of the disease, it can involve trachea, bronchial tree, pleura and lung parenchyma
• Diagnosis of respiratory disease is often made presumptively based on clinical/imaging appearance and exclusion of other entities. Biopsy is most definitive.
• Treatment of pulmonary disease almost always involves chemotherapy

Thoracic Imaging Findings

• Two patterns: interstitial and nodular
• Interstitial pattern -- septal lines, localized/focal consolidations, perihilar distribution, "flame-shaped" opacities
• Nodular pattern -- ill-defined nodules of various sizes that may coalesce into areas of patchy consolidation
• Up to 60% has pleural effusion
• Up to 16% has hilar/mediastinal lymphadenopathy

Our case: Kaposi's sarcoma, biopsy-proven

References:

Humes HD. Kelley's Essentials of Internal Medicine, 2001.

Parsons PE, Heffner JE. Pulmonary/reespiratory Therapy Secrets, 2002.