Crohn's Disease Pathology

Sofia Mendez Landron Claudia Rodriguez Samantha Abeja Courtney Jensen

Crohn's Disease Pathology

November 25th 2025

RTE 2563-2257-3201

People living with Crohn's or Colitis often face stomach pain, fatigue, joint pain, nausea, and more every single day, yet still show up and appear "normal" to the world. Remember, you can't always see the battles someone is fighting just by looking at them.

Crohn's Colitis Awareness

Fluoroscopy

What is it?

Conclusion

Symptoms

Modalities

Index

MR Entography

CT Entography

Ultrasound

What is Crohn's disease?

Ileocolitis

This is the most common of the 5 types of Crohn's Disease. It is a type of Inflammatory Bowel Disease that mainly affects the large and small intestine.

Crohn's Disease

Ileitis

Limited to the Ileum, causing inflammation.

Causes inflammation that can affect any part of the digestive tract, most often the end of the small intestine and start of the large intestine, and can extend through the bowel’s deeper layers.

Gastroduodenal Crohn’s disease

Another IBD that affects the stomach and the duodenum.

Jejunoileitis

There are many imaging modalities, including MRI. CT, Ultrasound, and Fluoroscopy can help diagnose and assess Crohn's Disease.

This affects the jejunum and ileum as well as the middle and lower areas of the small intestine.

Crohn’s colitis

This involves the GI tract and the colon.

Learn more

SYMPTOMS

ExtraintestinalSymptoms

• Severe mouth ulcers
• Fever
• Anemia
• Exhaustion

Once symptoms appear, patients are advised to undergo testing to determine which imaging modality is most appropriate for their particular type of Crohn's disease.

Digestive Symptoms

• Lower right abdominal pain
• Diarrhea (may contain blood or mucus)
• Gastrointestinal ulcers
• Rectal bleeding
• Anal fissures
• Nausea
• Vomiting,
• Appetite loss
• Weight loss
• Urgent need for a bowel movement

Imaging MODALITIES

MR Entography

Pros & Cons

Cross-sectional imaging using magnetic resonance enterography is frequently useful in identifying intestinal tract inflammatory sites in patients without rectal bleeding so that the endoscopic approach can be targeted.

• Doesn't use radiation,
• Multiple scans can be done at different times to get the best intestinal distention and see the colon and ileum clearly
• Although MRE offers the advantage of eliminating ionizing radiation, there is a lengthy scan time (25–45 minutes)
• Medical expenses
• Restrictions in several countries are the primary drawbacks.

Creeping fat - Also known as fibrofatty proliferation or fat wrapping. - Common in patients with longstanding Crohn's Disease - Shows fat surrounding the descending colon. It isolates the colon from surrounding bowel loops

Skip Lesions- Slip lesions and patchy inflammation are typical in Crohn's disease. - It is the interspaced inflammation "skipping" parts of the bowel, leaving areas unaffected (green arrows)

Loss of haustration - The image shows loss of haustral folds throughout the colon in a patient with chronic Crohn's disease. - Also known as "lead pipe" colon in patients with ulcerative colitis

Fistula - Can be seen going from one bowel loop to another hollow organ or the skin. - The image shows an enterovesical fistula (yellow arrow) originating from the small bowel.

Images of Crohns Disease in MR Entrography

https://radiologyassistant.nl/abdomen/bowel/crohn-s-disease

CT Entography

Most commonly used

In Computed Tomography Enterography, the ileum, colon, jejunum, and extraintestinal structures, including abscesses, fistulas, or blockages, can be clearly visualized.

• The mapping of the concentration of iodine may function as a sign of inflammation, with a quick acquisition time
• CTE and MRE show similar diagnostic sensitivity for identifying active inflammation in Crohn's disease
• When compared to small bowel follow-through, both CTE and MRE work (67–72%) better.

Objectives

CT Coronal contrast-enhanced image -Possible stricture in a patient with Crohn's disease. -Possible stricture in the small bowel wall (arrows)

CT Axial contrast-enhanced image - This image shows the small bowel wall thickening with a homogeneous, symmetric wall and the luminal wall narrowing (arrows). -Consistent with a patient with inflammation from Crohn's Disease

CT Coronal contrast enhanced image - Shows small bowel thickening, mural edema, luminal narrowing (arrow) consistent with a patient with Crohn's disease.

Images of Crohns disease in CT Entography

https://pubs.rsna.org/doi/abs/10.1148/rg.2020190091

Ultrasound

Valuable, nonivasive imaging alternative

By tracking disease activity and spotting complications like strictures, fistulas, or abscesses, intestinal ultrasound aids in the monitoring of inflammatory bowel disease (IBD)

• Gives doctors instant feedback on how successfully medications are reducing inflammation, enabling them to modify treatment as necessary.
• Can identify early indicators of illness recurrence following surgery, allowing for rapid intervention to stop symptoms from getting worse.
• Is a painless, radiation-free procedure that requires no special preparation
• Research shows it is more accurate than some stool tests
• Just as effective as colonoscopy or MRI for evaluating IBD, helping patients and providers make immediate, informed treatment decisions

Sonographic image that shows a patient with Inflammatory Bowel Disease, such as Crohn's. - Small bowel thickening at the right iliac fossa

Sonographic image showing abnormal distal and terminal ileum with the small bowel thickening. - Fat wrapping and areas of focal loss of gut wall; a distinct characteristic of an ulceration.

Sonographic image that shows a patient with Crohn's Disease.- Terminal Ileum is shown, as well as wall thickness. Intraperitoneal fluid and scattered bowel loops.

Images of Crohn's Disease in ultrasound

https://radiopaedia.org/search?scope=cases&commit=Search&q=Crohns+Disease+Ultrasound

Fluoroscopy

Real-time dynamic imaging modality

Visualize the small and large intestines, using barium-based imaging methods, such as small bowel and barium enemas

• Provides a clear visualization of bowel loops
• Allow for rapid assessment of issues using procedures such as fistulography or ileostomy enema
• However, does not provide information on extraluminal (outside the gut) structures
• Involves radiation exposure

Objectives

This image demonstrates a patient with pseudosacculation in Crohn's Disease. - Outpouching of the normal bowel wall along the antimesentric border.

Shows a terminal ileum with a string like narrowing and a long stricture segment. - A narrowing of the bowel causing spasms in Crohn's Disease.

Patient has a several year history of Crohn's Disease. - The arrows show the small oval-like dots of barium, compatible with ulcers, - The mucosal folds are thickened, consistent with inflammation.

Images of Crohns Disease in fluoroscopy

To sum it all up...

There isn't a single imaging technique that can be used to assess Crohn's disease. The management of this disease is complicated and needs to be adapted for each patient, taking into consideration the illness's severity, risk factors, patient preferences, and important clinical criteria such as age, disease location, and the existing patient history.

Conclusion

THANK YOU FOR LISTENING!