25 year old immegrant with chronic GI symptoms referred from GP for ultrasound
Ultrasound:
Findings:
Multiple thick walled small bowel loops in the left upper abdomen, suggestive of inflammatory bowel disease
Barium follow through:
Findings:
Loong segment narrowing of the jejunal loops with loss of mucosal pattern and bowel wall thickening
Diagnosis:
Crohn's disease
Discussion:
Normal bowel appears as 5 concentric alternate hypo and hyperechoic rings (gut signatue). The average thickness is 2-5mm.
Bowel wall thickening, inflammation of mesenteric fat, mesenteric lymphadenopathy, strictures and fistulas can be seen on US. Bowel wall thickening is usually symmetric with partial or total loss of normal bowel morphology or a 'pseudokidney' sign may be seen. Absence of peristalsis may be observed. The bowel is usually rigid and non-compressible. Angulation may be appreciated. Inflammation of mesentery is seen as echogenic mass (creeping fat). On Doppler, increased blood may be seen, suggestive of active disease. Strictures may be seen as luminal narrowing. Fistula is seen as hypoechoic linear tract with gas bubbles. Transvaginal ultrasound may be used in the diagnosis of rectovaginal and enterovesical fistulas. Inflammatory masses, abscesses are easily demonstrated on ultrasound. Involvement of the urinary bladder is better demonstrated on ultrasound. Presence of free air and bowel obstruction may also be diagnosed on ultrasound.
Ultrasound is 87% sensitive in the diagnosis of crohns disease.
References:
1. Damini N et al. Nongynecologic Applications of Transvaginal US. Radiographics. 1999;19:S179-S200
2. J Sarrazin and SR Wilson. Manifestations of Crohn disease at US. RadioGraphics 1996; 16: 499
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