Case of the Day: Do not forget the bowel – CEUS as a great complement in bowel evaluation.

Teaching Point:

Bowel/intestinal ultrasound is gaining ground for the evaluation of the bowel, predominantly for the assessment of inflammatory disease. However, ultrasound has also the ability to detect mural and luminal bowel masses. On this image/videoclip, there is a black crescentic mass-like area (arrow) that extends into the bowel lumen. However, greyscale alone cannot differentia between bowel content and a real neoplasm. Assessment of vascularity is a key component for the characterization of bowel masses.

Teaching Point:

CEUS confirms a hyperenhancing mural mass representing a colonic adenocarcinoma. Dual display demonstrates the hypoechoic mass on greyscale (Right) with the corresponding CEUS (left) showing homogenous hyperenhancement of the mass confirming a neoplasm. As opposed to bowel content which would be hypoenhancing and avascular.

Teaching Point:

CEUS PVP of the colonic mass shows washout at 1 minute confirming malignancy. This mass was resected with pathology confirming a colonic adenocarcinoma.

CEUS is an excellent modality for the evaluation of bowel masses. It assists in the differentiation of avascular bowel content and a real vascular mass. CEUS allows for easy detection of lesional vascularity, determination of its margins and extension. CEUS also assist in lesion localization either within the bowel wall, the lumen or both.