EURORAD ESR

Case 15402

Small bowel ischemia as the initial manifestation of vasculitis

Author(s)
Tonolini Massimo, M.D.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 50 year(s)
 
 
  • Figure 1
    Plain abdominal radiographs
     

    Supine (a) and upright (b) radiographs did not show pneumoperitoneum and bowel obstruction. A few small air-fluid levels (thin arrow in b) were noted in the small bowel. Faeces were present in several colonic tracts.

     
    Area of Interest: Small bowel; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Supine (a) and upright (b) radiographs did not show pneumoperitoneum and bowel obstruction. A few small air-fluid levels (thin arrow in b) were noted in the small bowel. Faeces were present in several colonic tracts.

     
    Area of Interest: Small bowel; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 2
    Unenhanced CT
     

    Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels (thin arrows). No pneumoperitoneum. Faeces in the right and transverse colon.

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels (thin arrows). No pneumoperitoneum. Faeces in the right and transverse colon.

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels. Additionally, prominent oedema and fluid were noted in the mesentery (+). Absent...

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 3
    Contrast-enhanced CT (6 hours after Fig.2)
     

    Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in...

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in...

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in...

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in...

     
    Area of Interest: Small bowel; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
  • Figure 4
    MR-enterography (MRE) two months after surgery
     

    Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.

     
    Area of Interest: Small bowel; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.

     
    Area of Interest: Small bowel; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.

     
    Area of Interest: Small bowel; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;

    Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.

     
    Area of Interest: Small bowel; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Ischaemia / Infarction;
     
     
Supine (a) and upright (b) radiographs did not show pneumoperitoneum and bowel obstruction. A few small air-fluid levels (thin arrow in b) were noted in the small bowel. Faeces were present in several colonic tracts.
 
Supine (a) and upright (b) radiographs did not show pneumoperitoneum and bowel obstruction. A few small air-fluid levels (thin arrow in b) were noted in the small bowel. Faeces were present in several colonic tracts.
 
Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels (thin arrows). No pneumoperitoneum. Faeces in the right and transverse colon.
 
Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels (thin arrows). No pneumoperitoneum. Faeces in the right and transverse colon.
 
Most of the small bowel from the third duodenum showed luminal overdistension with fluid (*) and formation of air-fluid levels. Additionally, prominent oedema and fluid were noted in the mesentery (+). Absent pneumoperitoneum and free ascites.
 
Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in the mesentery (+).
 
Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in the mesentery (+).
 
Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in the mesentery (+).
 
Rapid development of peritoneal effusion was noted. A long tract of proximal ileum (arrows) showed thickened, poorly enhancing walls with "target sign" stratified appearance. Prominent oedema and fluid were noted in the mesentery (+).
 
Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.
 
Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.
 
Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.
 
Follow-up MRE including T2-weighted (a..c) and gadolinium-enhanced T1-weighted (d) images showed normal post-surgical status after ileal resection for bowel ischaemia.
 
 
 
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