Presentation
Presented with abdominal pain, fever, and diarrhea.
Patient Data
- 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
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 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
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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