28-year-old man with history of Crohn's, now with right lower quadrant fullness and elevated CRP on infliximab therapy. ABDOMEN:LIVER, BILIARY TRACT: A few, punctate areas of T2 hyperintensity are noted, likely cysts. Liver is normal in signal and morphology. Gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cyst noted. No hydronephrosis or suspicious focal renal parenchymal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 9 cm area of circumferential bowel wall thickening with approximately 3.5 cm of narrowing involving the terminal ileum and ileocecal valve (3/18). This bowel wall enhances abnormally (20/90). Additionally, there is a 35 x 27 mm area of enhancing soft tissue in the medial mesentery (20/99) without fistulous tract identified.There is fibrofatty proliferation, regional lymphadenopathy measuring up to 13 mm (20/85), and free fluid (4/40). Proximally, the small bowel is dilated measuring up to 37 mm in diameter.The remainder of the colon appears normal. Jejunal loops are not well distended and difficult to evaluate however there are no gross signs of inflammatory change.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Inflammation involving the terminal ileum with stricturing and marked proximal dilation compatible with active Crohn's.2.Inflammatory soft tissue in the adjacent mesentery without discrete fistulous tract identified.