Figure 4.

Complicated Crohn's disease on ultrasound only. 45-year-old female with a 2-year history of Crohn's disease. Colonoscopy failed to intubate the terminal ileum and did not detect any active disease. (A) shows the ileocecal valve (ICV) and (B) shows a close-up view of the orifice with limited view of the terminal ileum (TI). (C) An axial ultrasound image of the TI shows mural thickening and surrounding inflammatory fat. The wall is eccentrically thickened and shows intramural extraluminal air (arrow), suggestive of localised perforation. A poorly marginated hypoechoic zone within the inflammatory fat suggests a phlegmon (P). (D) is the corresponding sagittal image of the thickened TI. Interpretation: acute local perforation and phlegmon. After ultrasound, the patient was referred to surgery.