A. Hollerweger et al., Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula-sonographic evaluation, EUR RADIOL, 11(10), 2001, pp. 1956-1963
Acute bowel inflammation frequently originates from thin-walled diverticula
of the colon. Not the presence of diverticula, but the demonstration of an
inflamed diverticulum, is diagnostic of diverticulitis in cases of bowel w
all thickening and pericolic inflammation. The aim of this study was to inv
estigate the sonographic appearance and detectability of inflamed diverticu
la. One hundred seventy-five consecutive patients with clinically suspected
diverticulitis under-went sonographic examination. Outpouchings from the c
olonic wall centred in the pericolic inflammation were considered inflamed
diverticula. Depending on the sonographic appearance they were divided into
four groups: hypoechoic; predominantly hyperechoic; hyperechoic with surro
unding hypoechoic rim; and hyperechoic with acoustic shadowing. Sonography
showed inflamed diverticula in 79 (77%) of 102 patients with diverticulitis
. Inflamed diverticula were hypoechoic in 37%, predominantly hyperechoic in
4%, hyperechoic with surrounding hypoechoic rim in 41% and hyperechoic wit
h acoustic shadowing in 18% of patients. In 23 (23%) of 102 patients no inf
lamed diverticulum was demonstrable. This group included 17 patients with c
omplicated diverticulitis and 6 false-negative cases. An inflamed diverticu
lum as a sign of diverticulitis yielded an overall sensitivity of 77% and a
specificity of 99%. Sensitivity in uncomplicated disease was 96%. In patie
nts with uncomplicated diverticulitis an inflamed diverticulum is a sign of
diverticulitis with excellent sensitivity and specificity, usually with so
litary and less frequently with more than one inflamed diverticulum being d
emonstrable. In patients with complicated diverticulitis an inflamed divert
iculum is often not detectable.