31 year old male patient with ileal Crohn's diease with phlegmon on OSH CT. Evaluate for resolution of phlegmon since starting Humira treatment. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter T2 hyperintense lesions within this spleen are compatible cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A right ureteral stent is in place without hydronephrosis. There is circumferential thickening and enhancement of the mid to distal right ureter in the region of the terminal ileum likely representing secondary inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and narrowing of approximately 14 cm of the terminal ileum which demonstrates progressive enhancement compatible with active inflammation. The appendix demonstrates wall enhancement as well. There is a fistulous connection between the terminal ileum to an adjacent small bowel loop within the right lower quadrant (image 62, series 15). Furthermore, there are inflammatory changes within the right lower quadrant with several sinus tracts (image 59, series 15). No drainable fluid collection is identified. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Enhancement, wall thickening, and narrowing of the terminal ileum compatible with active inflammation.2.Right lower quadrant enteroenteric fistula, inflammatory changes, and sinus tracts. No drainable fluid collection.3.Enhancement and thickening of the right ureter likely represent secondary inflammation from the adjacent terminal ileum. Right ureteral stent in place without hydronephrosis. 