Figure 1
US examination
Crohn disease diagnosed by ultrasound
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsGalanis S, Itzos V, Voultsinou D, Hatzigeorgiou C, Kalpakidis V
Connected authors
15 years, male
Clinical History
15-year old male evaluated for sub umbilical pain with relapsed episodes of diarrhea mixed with blood for over a period of one month.
Imaging Findings
A 15-year old male was evaluated for sub umbilical pain with relapsed episodes of diarrhea mixed with blood for over a period of one month. Prior to this recent episode he was admitted to another hospital and was treated for gastroenteritis. He had negative rebound tenderness, white blood cell count was 12000 and the plain x-ray radiograph had no pathologic signs.
US examination demonstrated sectional wall thickness in the distal ileum shown in the transverse and longitudinal view (Figures 1a,b). There were also two enlarged mesenteric lymph nodes (Figure 1c). Color and power Doppler examination showed an increase of mural blood flow (Figures 2a,b). The US findings along with the clinical history implied active Crohn disease. The additional imaging modalities used were CT and double contrast enteroclysis. The CT showed only segmental wall thickness in the terminal ileum (Figures 3a,b). The enteroclysis findings were linear ulcers in the terminal ileum (Figure 4).
US examination demonstrated sectional wall thickness in the distal ileum shown in the transverse and longitudinal view (Figures 1a,b). There were also two enlarged mesenteric lymph nodes (Figure 1c). Color and power Doppler examination showed an increase of mural blood flow (Figures 2a,b). The US findings along with the clinical history implied active Crohn disease. The additional imaging modalities used were CT and double contrast enteroclysis. The CT showed only segmental wall thickness in the terminal ileum (Figures 3a,b). The enteroclysis findings were linear ulcers in the terminal ileum (Figure 4).
Discussion
Crohn disease (CD) is a chronic granulomatus inflammatory disease of the gastrointestinal tract with a tendency toward remission and relapse. It can affect any part of the gastrointestinal tract, often involving multiple discontinuous sites. The small intestine is involved in 80% of cases, most commonly at the terminal ileum. The cause of CD is not known, however several factors are believed to be involved including infections, intestinal mucosal immune system abnormalities, genetic, mesenteric or vascular alterations, diet and psychogenic factors.
The first radiological findings include subtle elevation and aphthoid ulcers. As the disease progresses it extends transmurally to serosa and beyond to the mesentery and adjacent organs. Aphthoid ulcers develop into linear ulcers and fissures to produce an ulceronodular appearance. The bowel wall is thickened by a combination of fibrosis and inflammatory infiltrates. Bowel obstruction, strictures, abscesses or phlegmon, fistulas and sinus tracts are common complications of advanced disease. Ultrasonography can be used to assess the activity of CD by measuring the gut wall thickness and the increase of mural blood flow on color and power Doppler. Endoscope and barium studies have a principal role for diagnosis and evaluation of the disease but as far as the transmural, extramural and extra intestinal manifestation of the disease CT and MR imaging provide crucial information in the diagnosis and treatment planning.
The first radiological findings include subtle elevation and aphthoid ulcers. As the disease progresses it extends transmurally to serosa and beyond to the mesentery and adjacent organs. Aphthoid ulcers develop into linear ulcers and fissures to produce an ulceronodular appearance. The bowel wall is thickened by a combination of fibrosis and inflammatory infiltrates. Bowel obstruction, strictures, abscesses or phlegmon, fistulas and sinus tracts are common complications of advanced disease. Ultrasonography can be used to assess the activity of CD by measuring the gut wall thickness and the increase of mural blood flow on color and power Doppler. Endoscope and barium studies have a principal role for diagnosis and evaluation of the disease but as far as the transmural, extramural and extra intestinal manifestation of the disease CT and MR imaging provide crucial information in the diagnosis and treatment planning.
Differential Diagnosis List
Crohn disease
Final Diagnosis
Crohn disease
Case information
| URL: | https://eurorad.org/case/6693 |
| DOI: | 10.1594/EURORAD/CASE.6693 |
| ISSN: | 1563-4086 |
Figure 4
Enteroclysis
Figure 4. Double contrast enteroclysis demonstrates linear ulcers in the terminal ileum.
Enteroclysis
Figure 4. Double contrast enteroclysis demonstrates linear ulcers in the terminal ileum.