ULTRASOUND EVALUATION OF CA RECTUM

CASE HISTORY - A 40 yrs female with recurrent bleeding per rectum & lower abd pain .

AT USG -   On trans abd ultrasound focal iso to hypo & hyperechoic rounded lesions of variable size noted in liver with hypoechoic halo around ,s/o mets . Rest of abd scan was normal for abd viscera . To evaluate ano-colorectal region a non gyne TVS applied . Non gyne TVS application showed irregular hypoechoic mural thickening in rectum just above anorectal junction involving about 55 mm long segment with mural thickness ranging 10 to 14 mm distorting layer & mucosal pattern. The lesion was hyperemic on color Doppler. A tiny hypoechoic mural nodule also noted adjacently & separately   likely s/o satellite metastatic lesion . Multiple rounded hypoechoic perirectal lymphadenopathy also noted  . In view of above findings the diagnosis of Ca rectum was made with adjacent satellite mural lesion , perirectal metastatic lymphadenopathy  & hepatic metastasis .

Fig 1 - Hepatic scan showing mets

Fig 2- TVS scan with rectal evaluation showing perirectal nodes .

Fig 3- TVS scan showing irregular hypoechoic rectal wall thickening distorting gut signature  & adjacent tiny mural satellite lesion.

Fig 4- On color Doppler the rectal thickening showed hyperemia .

 

  This is how ultrasound completed the diagnosis & TVS helped in rectal evaluation in proper . 

PS - Histopathology revealed adeno ca rectum .