Figure 1
Small bowel follow-through
Note the ileal jejunalisation and the flattening jejunal folds.
Small bowel MRI in a patient with malabsorption syndrome
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsP. Paolantonio, C. Miglio, M. Celestre, D. Marin, F. Altomari
Connected authors
35 years, female
Clinical History
The patient presented with clinical symptoms of malbsorption.
Imaging Findings
The patient presented with clinical symptoms of malbsorption: abdominal cramping pain, chronic diarrhoea, anaemia, weight loss and vomiting and high values of EMA-ab.
A small bowel follow-through X-ray examination showed dilatation of small bowel loops with fold pattern reversal. An MR examination of the abdomen was performed after oral administration of polyethylene glycol contrast agent.
MR examination showed jejunal fold flattening with an increased number of ileal folds and some jejunal intussusception. In addition, the MR examination showed the following extra-intestinal findings: hyposplenism and a complicated cystic mass of the left kidney.
Discussion
One of the pathologies underlying a clinical picture of malabsorption is coeliac disease. Coeliac sprue is a relatively common disease in European countries with a prevalence ranging between 1:250 and 1:300; it occurs less frequently in the United States, where the prevalence is around 1:6000. However, precise estimation of prevalence is rather difficult, because a number of cases of coeliac sprue go clinically undetected with either silent or latent disease. Diagnostic imaging is useful for diagnosis, and is especially important in the presence of abdominal pain to exclude complicating lesions such as jejunal ulceration with stricture, intussusception, lymphoma, or carcinoma.
Radiological findings of coeliac disease include flattening of the jejuneal folds with an increased number of ileal folds (ileal jejunalisation), and dilatation of small bowel loops.
Differential Diagnosis List
Coeliac disease
Final Diagnosis
Coeliac disease
References
[1] Laghi A, Carbone I, Catalano C, Iannaccone R, Paolantonio P, Baeli I, Trenna S, Passariello R. Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel. AJR 2001;177:1333-4. (PMID: 11717077)
[2] Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. American Gastroenterological Association. Gastroenterology 2001;120:1526-40. (PMID: 11313324)
[3] Tomei E, Marini M, Messineo D, Di Giovambattista F, Greco M, Passariello R, Picarelli A. Computer tomography of the small bowel in adult celiac disease: the jejunoileal fold pattern reversal. Eur Radiol 2000;10:119-122. (PMID: 10663727)
Case information
| URL: | https://www.eurorad.org/case/1881 |
| DOI: | 10.1594/EURORAD/CASE.1881 |
| ISSN: | 1563-4086 |
Figure 2
PEG-MR examination
MR scan performed after oral administration of polyethylene glycol (PEG) solution: coronal image showing dilatation of small bowel loops with ileal jejunalisation.
MR scan on axial plane showing hyposplenism and a cystic mass of the left kidney.
MR scan on axial plane showing an ileal intussusception (target sign).
Small bowel follow-through
Note the ileal jejunalisation and the flattening jejunal folds.
PEG-MR examination
MR scan performed after oral administration of polyethylene glycol (PEG) solution: coronal image showing dilatation of small bowel loops with ileal jejunalisation.
MR scan on axial plane showing hyposplenism and a cystic mass of the left kidney.
MR scan on axial plane showing an ileal intussusception (target sign).