Sonographic features of acute colonic diverticulitis: The ?dome sign?

Abstract

Purpose This study was performed to clarify the sonographic features of acute colonic diverticulitis to enable its differentiation from appendicitis. Methods Of 119 patients who were referred to our hospitals for lower abdominal pain between June 1997 and December 1998 and underwent sonography, 12 patients had a definitive diagnosis of acute colonic diverticulitis and 4 patients a tentative diagnosis. Seventy‐eight patients were diagnosed as having acute appendicitis, confirmed by appendectomy. In the 16 patients with diagnoses of diverticulitis, the sonographic and clinical features of acute colonic diverticulitis were studied. Results Among the 12 patients with definitive diagnoses of acute colonic diverticulitis, sonographic findings included localized thickening of the colonic wall (100%) and a hemispheric mass (the “dome sign”) protruding at the thickened colonic wall (100%) and consisting of a hypoechoic wall (100%) and a central echogenic area (66%). The presence of diverticula was confirmed by barium‐enema x‐ray study in all 12 patients. The 4 patients with tentative diagnoses of acute colonic diverticulitis all had colonic wall thickening but no dome sign. Colonoscopy revealed colitis in 3 of these patients. All 16 patients recovered with conservative treatment, without laparotomy. Conclusions Sonography was useful for differentiating acute colonic diverticulitis from appendicitis. The sonographic finding of the dome sign seems to be specific for acute colonic diverticulitis. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:340–346, 2000.

Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel

“…In recent years, bowel ultrasound has gained importance as a reliable and non‐invasive imaging modality for the diagnostic work‐up and clinical follow‐up of patients with some inflammatory bowel disorders, such as Crohn's disease, appendicitis and diverticulitis 5–16 . This can be attributed to the technological advancement of ultrasound equipment which has greatly improved the resolution capability, with good cross‐sectional imaging of the gut wall and display of the surrounding mesentery, thus making it possible to detect the transmural extent of inflammation 3 .…”

“…Most existing trials have focused mainly on specific disease entities (i.e. Crohn's disease, ulcerative colitis, appendicitis, diverticulitis) 5–16 . In particular, in many of these reports, ultrasound was performed under optimal conditions (i.e.…”

“…Crohn's disease, ulcerative colitis, appendicitis, diverticulitis). [5][6][7][8][9][10][11][12][13][14][15][16] In particular, in many of these reports, ultrasound was performed under optimal conditions (i.e. not in the emergency setting, after other diagnostic procedures or by unblind investigators), or the sonographic results were somewhat biased by patient selection (i.e.…”

Statement of the Section Internal Medicine of the DEGUM – Ultrasound Obtains Pole Position for Clinical Imaging in Acute Diverticulitis

“…(3) In contrast to other guidelines the CDD for the first time favors abdominal US as the method of choice for cross sectional imaging. Because published work for now more than 25 years and the excellence of few individuals, etching the standing of US in their institutions in stone [2][3][4][5][6][7][8][9], may not represent general standards of US for diverticulitis, this paper attempts to outline the fundamental characteristics of diverticulitis at US as well as their technical and personal prerequisites against the back-…”

Solitary cecal diverticulitis: report of a case

“…Reports about detection of fecoliths on plain radiography are anecdotal [10,11]. On ultrasound typical hypo-or anechoic structures protruding from the colonic wall ("dome"-sign) can be found in diverticulitis [12]. A recent study showed a high sensitivity and specificity of ultrasound to diagnose right-colonic diverticulitis.…”