Contrast enhanced images of abdomen show moderate circumferential wall thickening of terminal ileum for a length of 5.0 cm and maximum wall thickness of 8 mm showing increased surrounding mesenteric vascularity (comb sign). There is severe narrowing at the level of thickening (representing stricture) with resultant moderate focal (<4 cm) distal ileal loop dilatation (3.7 cm in diameter). The dilated loop shows mottled intraluminal contents.
There is hypertrophy of peri-ileal fat in right iliac fossa.
Mucosal ulcers are seen in inflamed terminal ileum.
Focal areas of enteroenteric fistula are noted between the narrowed and dilated loops of terminal ileum.
No enterocutaneous fistulae noted.
These features are consistent with active (mucosal ulcers, enhancing wall thickening and comb sign) on chronic (stricture of terminal ileum and enteroenteric fistulae) Crohn disease.
Few small reactive mesenteric lymph nodes are noted in right iliac fossa.
Multiple simple hepatic cysts and trace bilateral pleural effusions are also noted.