Pediatric Ulcerative Colitis

Etiology: Idiopathic inflammatory bowel disease that is superficial in nature extending from rectum to proximal colon in a contiguous manner
Imaging Enema:
— Superficial bowel wall inflammation limited to colon and rectum
— See pseudopolyps in end stage which are areas of normal mucosa surrounded by denuded ulcerated mucosa
Imaging US:
— Thickening of cecum
— Bowel wall hyperemia
— Prominence of submucosa with preservation of layered structure of bowel wall which may be lost in advanced disease
DDX:
Complications: Extra-enteric manifestations include gallstones, primary sclerosing cholangitis, sacroiliitis, vascular complications
Treatment: Surgical which is usually curative
Clinical: Endoscopically visible as it affects the colon

Radiology Cases of Ulcerative Colitis

AXR of thumbprinting in ulcerative colitis — AXR shows thumbprinting throughout the transverse colon.

BE of ulcerative colitis — AP spot image of the rectosigmoid colon from a barium enema shows multiple fine mucosal ulcerations.

BE of ulcerative colitis — AXR AP from a barium enema (left) shows the loss of haustral markings in the colon (lead pipe sign). The magnified view (right) suggests the presence of multiple fine mucosal ulcerations.

Enema of pseudopolyps in ulcerative colitis — AP AXR (left) and magnified AP spot image of the splenic flexure (right) from a double contrast barium enema shows a large number of small polypoid lesions throughout the colon with the space between the polyps appearing to be denuded and ulcerated.

Enema of ulcerative colitis — AP image from an enema shows narrowing of the descending colon which was persistent along with fine mucosal ulcerations in the descending colon.

Gross Pathology Cases of Ulcerative Colitis

Pathological image of colonic pseudopolyps in ulcerative colitis — Pathological image of the colon shows colonic pseudopolyps.

Gross pathological image of ulcerative colitis — Gross pathological image of the sectioned colon shows colonic pseudopolyps throughout the length of the colon.

Pathology image of ulcerative colitis — Gross pathological image of the sectioned colon shows colonic pseudopolyps arising from the mucosa of the colon.