Kwashiorkor

Kwashiorkor is a condition characterized by bilateral edema caused by protein deficiency.

Epidemiology

The largest population at risk for the condition are children who have begun weaning from breast milk or formula towards diets without sufficient protein. Therefore, kwashiorkor often affects young children in areas of famine or extreme poverty, and the prevalence varies with disasters including war. Another population at risk for kwashiorkor are children with conditions affecting protein absorption.

Clinical presentation

Several clinical findings beyond edema may be seen including:

• hepatomegaly
• muscle wasting
• failure to thrive
• skin changes

Pathology

In addition to the direct effects of a lack of protein, i.e. edema and ascites, metabolic issues such as hypothermia and electrolyte imbalances can result from kwashiorkor. The condition affects development and even be fatal if untreated, although in some cases of death it is unclear if the condition was the cause of death or simply another effect of a different underlying pathology.

Radiographic features

There is no known radiologically pathognomonic sign for this condition, however, many of the complications do produce changes on imaging studies.

Plain radiograph / fluoroscopy

• delayed GI transit times may cause nonspecific signs of ileus on barium studies ²

Ultrasound

• low muscle volume
• hepatomegaly ³
• increased hepatic echogenicity (as a sign of hepatosteatosis) ³
• anechoic intraperitoneal fluid (ascites)

MRI

• cerebral atrophy ⁴