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Gastrointestinal Imaging (Beri) > Mesenteric Small Bowel (PBR 2) > Flashcards

Mesenteric Small Bowel (PBR 2) Flashcards

1
Q

CT and MR enterography findings that suggest malignant small bowel lesions

A
  1. Solitary lesions
  2. Nonpedunculated lesions
  3. Long-segment lesions
  4. Presence of mesenteric fat infiltration
  5. Presence of enlarged mesenteric lymph nodes (>1-cm short-axis diameter)
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2
Q

Most common neoplasm of the small intestine

They are considered a low-grade malignancy that may recur locally or metastasize to the lymph nodes, liver, or lung

A

Carcinoid tumors

Accounting for about one-third of all small bowel tumors

They arise from endocrine cells (enterochromaffin or Kulchitsky cells) deep in the mucosa

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3
Q

In carcinoid tumors

Only 7%, those with liver metastases, present with carcinoid syndrome because the liver inactivates the vasoactive substances

What are clinical presentation of carcinoid syndrome?

A

Cutaneous flushing, abdominal cramps, and diarrhea

*Creator’s notes:
Heart failure can also be included

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4
Q

Complications of carcinoid tumors

A 
Stricture
Obstruction
Bowel infarction (induced by fibrosis of the mesenteric vessels)
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5
Q

Can carcinoid tumor cause intussusception?

A

Yes

If they are pendunculated

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6
Q

Imaging signs of fibrosis and metastases of carcinoid tumors may resemble what disease?

A

Crohn disease

May overshadow primary tumor

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7
Q

Barium study findings of carcinoid tumor

A
  1. Luminal narrowing
  2. Thickened and spiculated folds
  3. Separation of bowel loops by mesenteric mass
  4. Bowel loops drawn together by fibrosis
  5. Primary lesion appearing as small (<1.5 cm) mural nodule or intraluminal polyp
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8
Q

CT and MR findings that are highly indicative of carcinoid tumor

A
  1. Sunburst pattern of radiating soft tissue density in the mesenteric fat due to mesenteric fibrosis
  2. Bowel wall thickening
  3. Primary lesion appearing as a small, lobulated soft tissue mass, occasionally with central calcification, usually in the distal ileum
  4. Marked contrast enhancement of the primary tumor mass
  5. Enlarged mesenteric nodes and liver masses due to metastatic disease
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9
Q

Adenocarcinoma of the small bowel is about half as common as carcinoid tumor

Where is it frequently seen in the small intestine?

A

Duodenum (50%) and proximal jejunum

Uncommon in distal ileum, where carcinoid is most common

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10
Q

Patients with what disease are at risk of small bowel carcinoma?

A

Adult celiac disease
Crohn disease
Peutz-Jeghers syndrome

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11
Q

Complications of small bowel adencarcinoma

A

Bleeding
Obstruction
Intussusception

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12
Q

What are the different tumor morphology of small bowel adenocarcinoma?

A
  1. Infiltrating producing strictures
  2. Polypoid producing filling defects
  3. Ulcerating
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13
Q

Most common location of infiltrating producing strictures of SB adenocarcinoma?

A

Jejunum

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14
Q

Most common location of polypoid producing filling defects of SB adenocarcinoma?

A

Duodenum

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15
Q

Barium study finding of SB adenocarcinoma

A

Typically show a characteristic “apple core” stricture of the small bowel

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16
Q

CT and MR findings of SB adenocarcinoma

A
  1. Solitary mass in the duodenum or jejunum (up to 8-cm diameter)
  2. An ulcerated lesion
  3. Abrupt irregular circumferential narrowing of the bowel lumen with abrupt edges to the wall thickening
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17
Q

Differential diagnosis of annular constricting lesions of the small bowel

A
  1. Small bowel adenocarcinoma
  2. Annular metastases
  3. Intraperitoneal adhesions
  4. Malignant gastrointestinal stromal tumors
  5. Lymphoma (rare)
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18
Q

Most common site for extranodal origin of lymphoma

A

GI tract

Small bowel is commonly involved

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19
Q

GI lymphoma involves what part of the small intestine?

A

Ileum with its high concentration of lymphoid cells in 60 to 65% pf cases and jejunum in 20 to 25%

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20
Q

Other risk factors for GI lymphoma

A 
Infections due to: 
H. pylori
HIV
Epstein-Barr virus
Hepatitis B vurys
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21
Q

Presenting symptoms of lymphoma

A 
Abdominal pain
Weight loss
Anorexia
GI bleeding
Bowel perforation
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22
Q

Morphologic pattern of involvement of GI lymphma

A
  1. Diffuse infiltration
  2. Exophytic mass
  3. Polypoid/nodular mass
  4. Multiple nodules
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23
Q

A feature of lymphoma which replaces the muscularis and destruction of the autonomic plexus by tumor without fibrosis

A

Aneurysmal dilation

As a result, obstruction is uncommon

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24
Q

Barium study fining of GI lymphoma

A
  1. Wall thickening with irregular, distorted folds due to submucosal infiltration of cells
  2. Fold thickening may be smooth and regular in early stages due to lymphatic blockage in the mesentery
  3. Folds become effaced in later stages with greater cell infiltration into the bowel wall
  4. Narrowed, widened, or normal lumen
  5. Cavitary lesions containing fluid and debris
  6. Polypoid masses that may cause intussusception
  7. Rare multiple filling defects that are larger than 4 mm, variable in size, and nonuniform in distribution

Shallow ulceration is common.

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25
Q

CT and MR finding of GI lymphoma

A
  1. Circumferential wall thickening involving a long segment of small bowel
  2. Effacement of folds
  3. Solid nodule, often polypoid
  4. Eccentric wall thickening
  5. Aneurismal dilation (lumen >4 cm)
  6. Stenosis of the lumen (rare)
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26
Q

Differentiating finding of lymphoma in comparison with GISTs and adenocarcinoma

A

Exophytic lymphoma is generally of uniform soft tissue density and enhances little, if any, with intravenous contrast administration

GISTs and adenocarcinoma usually enhance prominently

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27
Q

This refers to the sparing of rind of fat surrounding mesenteric vessels that are encased by lymphomatous nodes

A

“sandwich sign”

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28
Q

Lymphoma that usually presents with intestinal involvement, especially in the ileocecal area in children and young adults

The malignancy is aggressive, with rapid doubling time and poor prognosis

Imaging studies show bulky ileocecal mass

A

Burkitt lymphoma

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29
Q

This lymphoma is an aggressive high-grade non-Hodgkin lymphoma with poor prognosis

Extranodal involvement, including small bowel lymphoma, is common

Adenopathy may be caused by lymphoma, Kaposi sarcoma, or Mycobacterium avium-intracellulare infection

The radiographic findings are identical to those seen in immunocompetent patients

A

AIDS-relatd lymphoma

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30
Q

Difference of nodular lymphoid hyperplasia from lymphoma

A

By the uniform small size of the nodules (2 to 4 mm) and even distribution through the area of involvement

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31
Q

Location of lymphoid hyperplasia

A

Confined to the terminal ileum and proximal colon

May involve the entire small bowel

Usually considered incidental and may be related to recent viral infection

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32
Q

Associated disease of diffuse lymphoid hyperplasia

A

Hypogammaglobulinemia, especially low IgA

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33
Q

Metastases of the small bowel are less common then primary neoplasms

True or false

A

False

They are more common

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34
Q

Two most frequent routes of spread of to small bowel

A

Peritoneal seeding

Hematogenous spread

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35
Q

Peritoneal seeding involves what part of the small bowel?

A

Mesenteric border

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36
Q

Hematogenous spread implants on what part of the small bowel?

A

Antimesenteric border

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37
Q

Intraperitoneal implantation on the small bowel serosa is most commonly due to what cancers?

A

Ovarian carcinoma in women

Colon, gastric, and pancreatic carcinoma in men

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38
Q

Intraperitoneal implantation is most common at what part of the GI tract?

A

Terminal ileum, cecum, and ascending colon

Peritoneal implants on the parietal peritoneum, and omentum (omental cake), as well as in the pouch of Douglas, are demonstrated by CT

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39
Q

Hematogenous to the small bowel are seen in primary malignancies?

A

Melonoma
Lung, breast, colon carcinoma
Embryonal cell carcinoma of the testes

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40
Q

Imaging finding of small bowel metastases

A

Mural nodules of uniform or varying size anywhere in the small bowel

They may appear as target lesions, or ulcerate or cavitate

Direct extension to involve the small bowel is seen with malignancies of the pancreas and colon

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41
Q

Clinical presentation of GISTs of the small bowel

A

Obstruction or intestinal bleeding

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42
Q

Barium study findings of GISTs of the small bowel

A

Well-defined submucosal mass with smooth mucosa

Tumors that exceed 2 cm in size tend to ulcerate whether they are benign or malignant

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43
Q

CT findings of GISTs of the small bowel

A

Benign GISTs are homogeneous with attenuation similar to muscle

Malignant GISTs tend to be larger (>5 cm) and heterogeneous with prominent areas of low attenuation necrosis and hemorrhage

Nodal metastases are uncommon
Calcification is infrequent

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44
Q

Location of small bowel adenoma

A

It is more common in the duodenum than in the mesenteric small intestine

The tumor is a benign proliferation of glandular epithelium, and has the potential for malignant degeneration

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45
Q

Most common location of lipoma in small bowels

A

Ileum

The tumor arises from the fat of the submucosa

Lipomas account for about 17% of benign small bowel tumors

Most are asymptomatic incidental findings, although some cause bleeding or intussusception

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46
Q

Presentation of hemangioma in the small bowel

A

Solitary and submucosal, projecting into the lumen as polyp

Tumors are located predominantly in the jejunum

About two-thirds present with occult bleeding and anemia

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47
Q

This finding is occasionally seen in small bowel hemagioma and it suggest the diagnosis

A

Calcified phlebolith

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48
Q

Syndromes that cause multiple polypoid lesions of the small bowel

A

Polyposis syndromes

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49
Q

Differential diagnosis for polyposis syndrome

A 
Metastases
Lymphoma
Nodular lymphoid hyperplasia
Kaposi sarcoma
Carcinoid tumors
50
Q

This is an autosomal dominant inherited condition consisting of multiple hamartomatous polyps in the small intestine (most common), colon, and stomach associated with melanin freckles on the facial skin, palmar aspects of the fingers and toes, and mucous membranes

A

Peutz-Jeghers syndrome

51
Q

Polyps that are nonneoplastic, abnormal proliferation of all three layers of the mucosa, epithelium, lamina propria, and muscularis mucosae

A

Hamartomatous polyps

52
Q

Polyps of Peutz-Jeghers syndrome are commonly located where?

A

Jejunum

Usually pedunculated, and are variable in size up to 4 cm

53
Q

Patients with Peutz-Jeghers syndrome are at risk of what diseases?

A

Intussusception
GI tract adenocarcinoma
Extraintestinal malignancy (breast, pancreas, ovary)

54
Q

Barium study finding of Peutz-Jeghers syndrome

A

Myriad polyps in involved areas of small intestine, separated by normal bowel segments

55
Q

This is an inherited adenomatous polyposis coli usually includes a few adenomatous polyps in the small bowel

A

Gardner syndrome

*Creator’s notes:
Characterize by:
Familial adenopolyposis
Multiple osteomas: especially of the mandible, skull, and long bones
Epidermal cysts
Fibromatoses
Desmoid tumours of mesentery and anterior abdominal wall

56
Q

Ascaris lumbricoides mature where in the GI tract?

A

Worms mature in the small bowel, especially in the jejunum, and may reach 15 to 35 cm in size

New generations of infective ova are excreted in feces

57
Q

Barium study finding of ascariasis

A

Barium studies demonstrate worms as long linear filling defects

Barium ingested by the worms may be seen in their intestinal tract as a long, string-like white line

58
Q

Normal mesenteric lymph nodes diameter

A

Less than 5 mm in short-axis diameter

59
Q

Most common meseneteric mass

It causes bulky adenopathy

A

Lymphoma

Confluent adenopathy surrounds mesenteric vessels and fat producing the “sandwich sign”

Adenopathy is commonly present in the retroperitoneum and elsewhere

60
Q

The sandwich sign is specific to mesenteric lymphomas

True or false

A

True

61
Q

These are lymphangiomas that arise in the root of the small bowel mesentery

Most are thin walled and multiloculated with internal fluid that may be chylous, serous, or bloody

A

Mesenteric cysts

62
Q

Imaging findings of mesenteric cysts

A

US demonstrates a well-defined cyst with internal debris, and fluid-debris or fluid-fat levels

CT shows a cystic mass, displacing loops of small bowel anteriorly and laterally

On MR, cyst contents are hyperintense on T2WI and hypointense on T1WI when serous, or hyperintense on T1WI when chylous or hemorrhagic

*Creator’s note:
Remember chylous component

63
Q

This is a congenital, partial, or complete replica of the small bowel

Most arise from the distal small bowel and may communicate with the normal intestinal lumen at one or both ends, or not at all

They are lined by intestinal epithelium.

A

GI duplication cyst

US, CT, and MR reveal a thick-walled cyst with usually serous contents

Malignancies, primarily adenocarcinoma, may arise within duplication cysts

64
Q

This is an uncommon inflammatory condition affecting the root of the mesentery with variable inflammation, fat necrosis, and fibrosis

Lesions may be solitary or multifocal within the mesentery

Cause is unknown but the disease is associated with
other idiopathic inflammatory disorders including retroperitoneal fibrosis and sclerosing cholangitis

A

Mesenteric panniculitis (sclerosing mesenteritis)

Patients commonly present with abdominal pain

65
Q

CT shows localized increase in fat density in the mesentery

This finding is known as what?

A

“misty mesentery”

66
Q

Cause of misty mesentery

A

Mesenteric infiltration by edema, inflammatory cells, neoplastic cells, or fibrosis

Mesenteric panniculitis can be diagnosed as the cause of misty mesentery if other causes are excluded

67
Q

Mesenteric edema may occur in what processes?

A

Portal hypertension
Cardiac or renal failure
Hypoproteneimia

*Creator’s note:
Like any other cause of edema

68
Q

What are the 5 rules of diffuse small bowel disease

A 
#1 Dilation of the small bowel lumen means small bowel obstruction or dysfunction of small bowel muscle
#2 Thickening of small bowel folds means infiltration of the submucosa
#3 Uniform, regular, straight thickening means infiltration by fluid (edema or blood)
#4 Irregular, distorted, nodular thickening means infiltration by cells or nonfluid material
#5 The specific diagnosis requires matching the small bowel pattern with clinical data
69
Q

This disease affects the small bowel in 60% of patients producing atrophy of the muscularis by the process of progressive collagen deposition resulting in flaccid, atonic, often greatly dilated small bowel

The valvulae conniventes are normal or thinned

A

Scleroderma

70
Q

A “hide-bound” appearance of thinned folds tethered together is produced by contraction of the longitudinal muscle layer to a greater extent than the circular muscle layer

This is seen on what disease?

A

Scleroderma

Excessive contraction of the mesenteric border of the small bowel results in formation of mucosal sacculations along the antimesenteric border

71
Q

In scleroderma, what part of the small bowels are more severely involved?

A

The jejunum and duodenum are more severely involved than the ileum

72
Q

How is scleroderma diagnose?

A

The diagnosis is confirmed by skin changes and characteristic involvement of the esophagus

Malabsorption eventually occurs

High-resolution chest CT is required to document pulmonary involvement

73
Q

Also known as nontropical sprue

This disease presents with malabsorption, steatorrhea, and weight loss

Gluten, an insoluble protein found in wheat, rye, oats, and barley, acts as a toxic agent to the small bowel mucosa

The mucosa becomes flattened and absorptive cells decrease in number; villi
disappear

A

Adult celiac disease

The submucosa, muscularis, and serosa remain normal

Findings and symptoms resolve with a strict gluten-free diet

74
Q

Complications of celiac disease

A 
Intussusception
Lymphoma
Ulcerative jejunoileitis
Cavitating lymphadenopathy sydrome
Pneumotosis intestinalis
75
Q

Classic radiographic findings of celiac disease

A
  1. Dilated small bowel
  2. Normal or thinned folds
  3. Decreased number of folds per inch in the jejunum
  4. An increased number of folds per inch in the ileum (≥5)

Findings are best demonstrated by standard or CT enteroclysis

Five or more folds per inch in the jejunum make the diagnosis unlikely

76
Q

CT enterography findings of celiac disease

A
  1. Reversed jejunoileal fold pattern with loss of folds in the jejunum and increased number of folds in the ileum
  2. Small bowel dilation
  3. Increased separation of small bowel folds
  4. Mesenteric lymphadenopathy
  5. Engorgement of mesenteric vessels

*Creator’s notes:
All appears to be nonspecific except for #1

77
Q

This disease has similar clinical and radiographic findings as nontropical sprue but is confined to India, the Far East, and Puerto Rico

A

Tropical sprue

Illness starts with acute diarrhea, fever, and malaise and transitions to chronic steatorrhea, weight loss, malaise, and nutrient and vitamin deficiencies

The cause is unknown but the disease responds to administration of folate and antibiotics

78
Q

Secondary lactase deficiency may develop in what cases?

A

Alcoholis, Crohn disease, and drugs such as neomycin

The nondigested lactose in the small bowel causes increased intraluminal fluid and dilated small bowel with normal folds

79
Q

Disease that may result from embolism or thrombosis of the superior mesenteric artery or vein

Patients may present with an acute abdomen or vague symptoms

A

Intestinal ischemia

80
Q

In intestinal ischemia:

What are the causes of arterial occlusion?

A

May be due to embolus, vasculitis, trauma, or adhesions

81
Q

In intestinal ischemia:

What are the causes of venous thrombosis?

A

Hypercoagulability states (neoplasms, oral contraceptives)
Inflammation (pancreatitis, peritonitis, abscess)
Stasis (portal hypertension, congestive heart failure)

82
Q

Radiograph findings of intestinal ischemia

A

Gaseous distention
Thickened mucosal folds (thumbprinting)
Intramulra or portal venous gas (in some cases)

83
Q

Diagnostic imaging method of choice for intestinal ischemia

A

MDCT with intravenous contrast

84
Q

CT findings of intestinal ischemia

A
  1. Diffuse thickening of the bowel wall, usually to 8 to 9 mm, rarely exceeding 15 mm
  2. Thinning of the bowel wall may occur in acute arterial occlusion caused by loss of intestinal muscle tone and tissue volume loss with vessel constriction
  3. Low attenuation of the bowel wall is caused by edema
  4. High attenuation of the bowel wall is caused by intramural hemorrhage
  5. Lack of or decreased bowel wall enhancement is highly specific for acute ischemia
  6. Pneumatosis of the thickened bowel wall may indicate transmural infarction
  7. Dilation of the bowel wall occurs with adynamic ileus; 8. Mesenteric vessels with emboli or thrombi fail to enhance following intravenous contrast administration
  8. Mesenteric fat stranding and ascites are commonly present

*Creator’s notes
Already discussed on Acute Abdomen

85
Q

This occurs when large doses of radiation are give to adjacent organs

A

Radiation enteritis

The small bowel is the most sensitive organ in the abdomen

86
Q

Pathological process of radiation enteritis

A

Long segments of bowel may be involved, with thickening of folds and bowel wall
Peristalsis is impaired
Progressive fibrosis leads to tapered strictures commonly involving long segments
The bowel may be kinked and obstructed by adhesions
Fistulas to the vagina or other organs may also result

*Creator's notes:
In short: 
Thickened wall of log segments of the bowel with possible strictures and adhesions
Impaired peristalsis
Fistulas
87
Q

CT findings of radiation enteritis

A

Wall thickening and increased density of the mesentery, and fixation of bowel loops

Diagnosis is confirmed by researching the radiation field and dose

88
Q

This refers to gross dilation of the lymphatic vessels in the small bowel mucosa and submucosa

The primary form is a congenital lymphatic blockage, often associated with asymmetric edema of the extremities

A

Lymphangiectasia

Despite being congenital, symptoms often do not occur until young adulthood

Patients present with protein-losing enteropathy, diarrhea, steatorrhea, and recurrent infection

89
Q

Causes of secondary lymphangiectasia

A

Lymphatic obstruction due to radiation, congestive heart failure, or mesenteric node involvement by malignancy or inflammation

90
Q

How is lymphangiectasia diagnosed?

A

Jejunal biopsy

91
Q

Barium study findings of lymphangiectasia

A

Diffuse fold thickening that is most pronounced in the jejunum, increased intraluminal fluid, and groups of tiny (1 mm) nodules due to distended villi

Pattern closely resembles Whipple disease

CT helps the differentiation by revealing thickening of the bowel wall and mesenteric adenopathy in secondary lymphangiectasia

92
Q

This is a disease complex associated with extracellular infiltration of an amorphous protein material in body tissues

The disease may be primary or associated with multiple myeloma (10% to 15%), rheumatoid arthritis (20% to 25%), or tuberculosis (50%)

A

Amyloidosis

Most cases are systemic, but 10% to 20% are localized

93
Q

The small bowel is the most common site of GI involvement of amyloidosis

True or false

A

True

Amyloid deposits are seen throughout the wall of the small bowel, especially within the walls of small blood vessels resulting in ischemia and infarction

Deposits in the muscularis impair motility. Diffuse, irregular thickened folds may be seen throughout the small bowel

Nodules are sometimes present

94
Q

CT finding of small bowel amyloidosis

A

CT demonstrates symmetric wall thickening of affected bowel without luminal dilation or hypersecretion

Small mesenteric lymph nodes may be evident

Diagnosis is confirmed by biopsy

95
Q

This is s a myeloproliferative neoplasm characterized by infiltration of mast cells in the skin, bones, lymph nodes, liver, spleen, and GI tract

A

Systemic mastocystosis

Osteoblastic bone changes are found in 70% of cases Lymphadenopathy and hepatosplenomegaly are often present

The bowel wall and mucosal folds are thickened, and mucosal nodules up to 5 mm size are often evident

96
Q

Characteristic skin manifestation of systemic mastocytosis

A

Urticaria pigmentosa

97
Q

This is an uncommon systemic disorder affecting the GI tract, joints, central nervous system, and lymph nodes

The disease is caused by Whipple bacilli, gram-positive, rod-shaped bacteria that are found within macrophages in many organs and tissues

A

Whipple disease

Patients may present with arthritis, neurologic symptoms, or steatorrhea

Generalized lymphadenopathy is usually present

98
Q

Imaging findings of Whipple disease

A

Irregularly thickened folds most prominent in the jejunum

Demonstration of tiny (1 mm) sand-like nodules spread diffusely over the mucosa or in small groups is strong evidence of the disease

Increased luminal fluid is usual

CT reveals thick folds especially in the jejunum without significant dilation
Low-density or fat density nodes in the mesentery are characteristic

*Creator’s notes:
Remember sand-like nodules

99
Q

Infectious agents that appears in AIDS enteritis

A

Cryptosporidium and Isospora belli
Cytomegalovirus
Mycobacterium avium-intracellulare

Candida, Amoeba histolytica, Gardia, Strongyloides, herpes simplex, and Campylobacter may also occur in AIDS patients

100
Q

This is a common inflammatory disease of uncertain etiology that may involve the GI tract from the esophagus to the anus

The disease is characterized by erosions, ulcerations, full-thickness bowel wall inflammation, and formation of noncaseating granulomas

A

Crohn disease

Patients present, usually in their teens, 20s, and 30s, with diarrhea, abdominal pain, weight loss, and often fever

101
Q

Patterns if GI involvment of Crohn disease

A

Colon and terminal ileum (55%)
Small bowel alone (30%)
Colon alone (15%)
Proximal small bowel without terminal ileum (3%)

102
Q

Imaging hallmarks of Crohn disease

A
  1. Aphthous erosions
  2. Confluent deep ulcerations
  3. Thickened and distorted folds
  4. Fibrosis with thickened walls, contractures, and stenosis
  5. Involvement of the mesentery
  6. Asymmetric involvement both longitudinally and around the lumen
  7. Skip areas of normal intervening bowel between disease segments
  8. Fistula and sinus tract formation
103
Q

These are shallow, 1- to 2-mm depressions usually surrounded by a well-defined halo

A

Aphthous ulcers

104
Q

What produces the “cobblestone pattern” in Crohn disease?

A

Deep ulcerations - forming fissures between nodules of elevated edematnous mucosa

105
Q

What produces the “string sign” in Crohn disease

A

Fibrosis and progressive thickening of the bowel wall narrow the lumen, particularly the terminal ileum

106
Q

Mesenteric involvement is best demonstrated by CT or MR.

What are the mesenteric findings in Crohn disease?

A

Ulceration along the mesenteric border may extend between the leaves of the mesentery

The mesenteric fat is infiltrated; the mesentery is thickened and retracted

107
Q

Crohn disease:

What are the findings indicative of active inflammation?

A
  1. Wall thickening (>3 mm)
  2. Layered pattern of wall enhancement
  3. The “comb sign” of fibrofatty proliferation around inflamed bowel segments with engorged mesenteric vessels forming the comb
  4. On MR high signal intensity of the thickened bowel wall on T2WI with fat saturation

Diffusion- weighted MR enterography shows restricted diffusion in acutely inflamed small bowel

108
Q

Complications of Crohn disease

A

Obstruction
Fistulae (MC ileocolonic and ileocecal) and sinus tract formation
Abscess and phlegmon formation
Perforation
Carcinomas
Derangement of intestinal absorption - Megaloblastic anemia (Vit B12 deficiency)
Increased incidence of gallstones and renal stones

20% of patients have arthritis or spondylitis that mimics ankylosing spondylitis

109
Q

This is caused by infection with the gram-positive bacilli, Y. enterocolitica, or Y. pseudotuberculosis

Infection causes acute enteritis with abdominal pain, fever, and often bloody diarrhea that mimics acute appendicitis or acute Crohn disease

Children and young adults are most often affected

A

Yersinia enterocolitis

Children and young adults are most often affected. The infection runs a self-limited course of 8 to 12 weeks

Diagnosis is confirmed by stool culture

110
Q

Imaging findings of Yersinia enterocolitis are most pronounced at what part of the small intestine?

A

Distal 20 cm of the ileum

Aphthous ulcers, nodules up to 1 cm in size, wall thickening, and thickened folds that become effaced with increasing edema

Nodular lymphoid hyperplasia may appear during the resolution stage

*Creator’s note
Not very specific except for the location

111
Q

This disease is a multisystem disease due to a small vessel vasculitis that affects eyes, joints, skin, central nervous system, and the intestinal tract

Prominent clinical features include relapsing iridocyclitis, mucocutaneous ulcerations, vesicles, pustules, and mild arthritis

A

Behcet disease

Intestinal disease most commonly involves the ileocecal region, where Crohn disease is closely mimicked with aphthous erosions, deep ulceration, stenosis, and fistula formation

Complications include bowel perforation and peritonitis

The cause is unknown and there is no cure

The disease is most common in the Middle East, especially Turkey, and Asia

112
Q

General presentation of GI tuberculosis

A

Presents as peritonitis or focal infection of the gut, most commonly involving the ileocecal area, closely mimicking Crohn disease

Less than half of the patients have concurrent evidence of pulmonary tuberculosis

113
Q

Imaging finding of GI tuberculosis

A

Barium studies:
Inflamed mucosa with transverse and stellate ulcers
The affected bowel becomes rigid and narrowed with nodular mucosa
The ileocecal valve is stiff and gaping with narrowed terminal ileum and cecum

CT:
Mesenteric adenopathy, high- density ascites, and peritoneal thickening and enhancement accompanying the bowel wall thickening

114
Q

Most common location of small bowel diverticula

A

Jejunum along the mesenteric border

They are outpouchings of mucosa through the bowel wall and between the leaves of the mesentery

They are commonly multiple and often asymptomatic

115
Q

Complications of small bowel diverticula

A

Malabsorption
Vit B12 absorprtion - Megaloblastic anemia
Obstruction, acute diverticulitis, hemorrhage, and volvulus

116
Q

Imaging findings of small bowel diverticula

A

Conventional radiographs:
Featureless ovoid collections of air

Barium study:
Outpouchings, most with a neck smaller in diameter than the outpouching itself
The diverticulum lacks mucosal folds and does not contract because of the lack of muscle within its wall

CT:
Discrete, round or ovoid, structures outside the expected lumen of the small bowel
They may be filled with air, fluid, or contrast and have a thin smooth wall

117
Q

Most common congenital anomaly of the GI tract

A

Meckel diverticulum

118
Q

Length and location of Meckel diverticulum

A

2 to 8 cm in length

Located on the antimesenteric border of the ileum up to 2 m from the ileocecal valve

119
Q

The tip of the diverticulum may be attached to the umbilicus by what vestigial structure?

A

A remnant of the vitelline duct

Ectopic gastric mucosa is present in up to 62% of cases

120
Q

Complications of Meckel diverticulum

A

Ulceration and bleeding (ectopic gastric mucosa, peptic secretion)

Other complications:
Intussusception, volvulus, and perforation

121
Q

Test of choice for Meckel diverticulum

A

Radionuclide (Tc-99m pertechnetate) scanning for ectopic gastric mucosa is the test of choice but is less reliable in adults than in children, and is negative when the diverticulum does not contain gastric mucosa

Enteroclysis is then the best method to demonstrate the diverticulum, which appears as a blind sac attached to the antimesenteric border of the ileum

CT:
Meckel diverticulitis appears as a blind-ending pouch of variable size and wall thickness with inflammatory changes in adjacent mesentery

122
Q

These are outpouchings along the antimesenteric border of the small bowel that result from disease of the small bowel

They occur most commonly in association with Crohn disease or scleroderma

A

Pseudodiverticula or sacculations

With fibrosis and contraction of the mesenteric border of the bowel, the unsupported antimesenteric border becomes pleated and forms sacculations

Gastrointestinal Imaging (Beri) (26 decks)

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