Crohns disease

Cobblestoning (Ulceronodular Pattern)

Crohn's disease is pathologically characterized by deep, knifelike clefts that

penetrate the submucosa and muscularis propria. These deep, linear
ulcerations form the basis of "cobblestoning," fissures and fistulas.
Transversely and longitudinally oriented knifelike clefts join to form a
network of deep ulcers. Relatively spared mucosa remains between these
linear ulcerations, resulting in a cobblestone appearance. Radiographically,
barium fills a reticular network of grooves that surround round or ovoid
radiolucent islands of mucosa. This pattern is more appropriately called the
ulceronodular pattern. Endoscopically, cobblestoning has a spectrum of
appearance from nodular mucosa to criss-crossing, furrowed ulcerations.

Crohns disease

Endoscopic appearance of
cobblestoning in Crohn's
disease. Crisscrossing,
furrowed ulcerations are
seen in the colon.

Crohns disease

Enteroclysis of 30-year-old
patient with worsening diarrhea
and abdominal pain shows deep
marginal protrusions (arrows)
along mesenteric margin of
distal ileum consistent with
deep ulcers. A cobblestone
mucosa also is seen. Separation
between bowel loops suggests
wall thickening exaggerated by
the compression paddle. C,
cecum.

Crohns disease

Cobblestone mucosa
manifested by crisscrossing
linear ulcers separated by
mounds of edema suggestive of
severe inflammation of a long
segment of distal ileum (arrow)
in another patient.

Crohns disease

CT enteroclysis with positive

enteral contrast of a 17-year-old
male with worsening diarrhea and
weight loss shows cobblestone
mucosa of a long segment of distal
small bowel. Mounds of edema are
manifest by ovoid or nodular
defects and ulcerations manifest as
irregular marginal protrusions
(arrow in one) in the bowel wall.
The involved segment also shows a
thickened wall.