28-year-old male with Crohn's disease flare. Abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The liver is diffusely enlarged with a craniocaudal dimension of 20.7 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings consistent with Crohn's disease identified throughout the colon including attenuated caliber, post-inflammatory polyps and global loss of haustration. Distal ileum and cecum and descending colon wall thickening are best demonstrated on coronal image 50/71. The wall thickening is most pronounced at the splenic flexure seen best at the splenic flexure on axial image 45/147 of series 3 and coronal image 27/71.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free or loculated fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a small collection of air in the right perianal region with fluid density and may represent a fissure and tract seen best on axial image 128/147 and coronal image 22/71. This may be further evaluated with an MRI examination if indicated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
Diffuse changes in the colon compatible with long-standing Crohn's disease. Wall thickening is most pronounced at the distal ileum, cecum, ascending colon, and splenic flexure. Probable right sided perianal fissure and tract. See above.