RJ is a 57-year-old male with a history of infiltrating adenocarcinoma of the colon confirmed by colonoscopic biopsy and resected 11 days later.
The patient did well for almost 3 years, when he had rectal bleeding. Colonoscopy revealed what appeared to be friable tumor but histology was negative. An abdominal x-ray performed a week later was negative.
The patient underwent a CEA-Scan study three days later. The scan was positive for a tumor on the left side of the pelvis (circled in transaxial image at right, coronal view at left).
A chest CT was negative. A CT of the abdomen and pelvis (below) performed the same day revealed nonspecific hypodensities in the liver and mild mural thickening (circled area) within the sigmoid colon which was reported as "may be secondary to post-surgical changes/underfilling with contrast, but cannot definitely exclude recurrent neoplasm."
An exploratory laparotomy and low anterior resection the following week found no palpable liver lesions and a 4-cm adenocarcinoma at the rectosigmoid junction. Thus, CEA-Scan correctly identified the source of the bleeding in an area that was equivocal on both CT scan and colonoscopy.
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