Patient Data
On AXR, the large bowel appears to be enlarged especially the ascending and transverse colon. No evidence of distal large bowel enlargement suggest a transition point just distal to the splenic flexure which can be vaguely seen.
There is incidental finding of scoliosis of vertebrae and right femur head replacement
After administration of oral contrast, apple core lesion can be identified in patient's proximal descending colon. The lumen is narrowed by muscle density mass protruding form the wall of the colon best seen in coronal view. The large bowel proximal to this point is distended without however evidence of a small bowel obstruction.
The liver demonstrates a number of ill-defined lesions the largest of which in segment 8 potentially representing a metastasis. A smaller segment 6 lesions probably represents a cyst.
Incidental finding of degenerative scoliosis with multiple osteophytes.
Case Discussion
The classic apple core sign can sometimes be appreciated on plain films and is highly suggestive of a stenosing adenocarcinoma. It is most frequently seen in the descending and sigmoid colon.
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