Crohn's disease

Case contributed by Dr Mohamed Samy

Presentation

Presented with abdominal pain, fever, and diarrhea

Patient Data

Age: young adult
Gender: Female
Barium
  • stricture of the terminal ileum demonstrating cobblestone appearance
  • displacement/spacing of the surrounding bowel loops reflecting mesenteric fat inflammation and hypertrophy
  • the cecum appears normal
  • no evidence of other small bowel segments involvement or fistula
MRI
  • the terminal ileum demonstrates wall thickening of layered pattern with moderate to marked contrast enhancement, in keeping with severe inflammatory process
  • the elevated signal on thickened walls on T2-FS images is suggestive of an active inflammatory disease
  • the absence of signal loss of the bowel wall on the fat suppression sequences implies bowel wall edema (fluid signal - not fat), which is in turn suggestive of an active disease (in contrast to chronic disease in case of fat signal)
  • right lower abdominal quadrant mild free fluid and mesenteric vessels congestion (comb sign)
  • no evidence of abscess formation
  • normal appearance of the cecum
  • no evidence of other bowel loops segments involvement 
Annotated image

Barium follow through study annotated

  • Red arrows: terminal ileum stricture with cobblestone pattern
  • Blue arrows: normally appeared cecum
  • Yellow dots: displacement/spacing of the surrounding bowel loops reflecting mesenteric fat inflammation and hypertrophy

Case Discussion

The differential diagnosis for such findings includes: small bowel lymphoma, tuberculosis, and ulcerative colitis

  • the normal appearance of the cecum makes tuberculosis less likely
  • the absence of lymphadenopathy or bowel mass makes lymphoma less likely
  • the normal appearance of the rectum makes ulcerative colitis less likely

Endoscopy with biopsy would provide the diagnosis. The main role of radiology in Crohn's disease is follow up and detection of complications.

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Case information

rID: 61583
Published: 11th Jul 2018
Last edited: 12th Jul 2018
Inclusion in quiz mode: Included
Institution: Private practice

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