Figure 1
Segmental thickened bowel loop
Arrow shows a segmental thickened bowel loop.
Crohn's disease
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsDr Utkarsh Kabra, Dr Alka Goyal
Connected authors
37 years, female
Clinical History
Chronic abdominal pain and altered bowel habits.
Imaging Findings
Multiple areas of small bowel thickening with intervening skip areas. Few long segment areas of small bowel thickening, mesenteric vascular engorgement with multiple enlarged mesenteric lymph nodes.
Discussion
In a patient who presents with a chronic history of abdominal pain and altered bowel habits, inflammatory bowel disease should be a consideration.
A CE CT abdomen is the investigation of choice in such cases.
In the above case there were multiple areas of small bowel thickening with skip areas, few long segment small bowel thickenings, mesenteric vascular engorgement and enlarged mesenteric lymph nodes [1].
All these findings favour the diagnosis of inflammatory bowel disease, most likely Crohn's.
The differentials under consideration were ulcerative colitis and tuberculosis.
In ulcerative colitis there is continuous involvement of the bowel without any skip areas starting from the rectum and proceeding proximally.
In tuberculosis there is predominant involvement of the caecum and ileocaecal junction and necrotic, caseous lymphadenopathy. Skip areas and mesenteric vascular engorgement are absent.
A CE CT abdomen is the investigation of choice in such cases.
In the above case there were multiple areas of small bowel thickening with skip areas, few long segment small bowel thickenings, mesenteric vascular engorgement and enlarged mesenteric lymph nodes [1].
All these findings favour the diagnosis of inflammatory bowel disease, most likely Crohn's.
The differentials under consideration were ulcerative colitis and tuberculosis.
In ulcerative colitis there is continuous involvement of the bowel without any skip areas starting from the rectum and proceeding proximally.
In tuberculosis there is predominant involvement of the caecum and ileocaecal junction and necrotic, caseous lymphadenopathy. Skip areas and mesenteric vascular engorgement are absent.
Differential Diagnosis List
Crohn's disease
Ulcerative colitis
Tuberculosis
Final Diagnosis
Crohn's disease
References
[1] Furukawa A, Saotome T, Yamasaki M et al. (2004) Cross-sectional imaging in Crohn disease. Radiographics May-Jun;24(3):689-702 (PMID: 15143222)
Case information
| URL: | https://www.eurorad.org/case/13983 |
| DOI: | 10.1594/EURORAD/CASE.13983 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Thickened bowel loops
Arrows show thickened bowel loops.
Figure 3
Thickened bowel loops and enlarged lymph nodes
Arrows show thickened bowel loops and enlarged mesenteric lymph nodes.
Figure 4
Enlarged mesenteric lymph nodes
Arrows showing enlarged mesenteric lymph nodes.
Figure 5
Thickened bowel loop
Arrows show another thickened bowel loop
Figure 6
Mesenteric vascular engorgement
Large arrows show mesenteric vascular engorgement and the small arrow shows a thickened bowel loop.
Figure 7
Long segment thickening
Arrows show long segment thickening of a bowel loop.
Segmental thickened bowel loop
Arrow shows a segmental thickened bowel loop.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Thickened bowel loops
Arrows show thickened bowel loops.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Thickened bowel loops and enlarged lymph nodes
Arrows show thickened bowel loops and enlarged mesenteric lymph nodes.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Enlarged mesenteric lymph nodes
Arrows showing enlarged mesenteric lymph nodes.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Thickened bowel loop
Arrows show another thickened bowel loop
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Mesenteric vascular engorgement
Large arrows show mesenteric vascular engorgement and the small arrow shows a thickened bowel loop.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital
Long segment thickening
Arrows show long segment thickening of a bowel loop.
Getwell Poly Clinic & Hospital
Getwell Poly Clinic & Hospital