Small bowel Crohn's disease on ultrasound

Case contributed by Dr Joe Mullineux

Presentation

Abdominal pain and diarrhea with raised fecal calprotectin and CRP.

Patient Data

Age: 30 years
Gender: Female

Bowel ultrasound

Ultrasound

A normal abdominal ultrasound examination was performed before a focused bowel ultrasound assessment with high frequency probe and graded compression technique1. No bowel preparation.

Abnormal distal and terminal ileum showing an extensive segment (>30cm) of significant transmural small bowel thickening (>4cm). There are areas of focal loss of gut wall signature in keeping with ulceration (red line). There is significant fat wrapping.  Within there TI on color and power doppler in keeping with hyperemia (should be absent in normal bowel).

The colon appears normal. No fistula or collection. Small volume of free fluid is noted in the right iliac fossa.

Findings are consistent with active small bowel Crohn's disease over a significant length of distal and terminal ileum. Diagnosis was confirmed endoscopically.

Case Discussion

Imaging and endoscopy are essential for diagnosis and assessment of treatment response in IBD.

Cross-sectional imaging with CT and MR enterography has a key established role in mapping and assessing small bowel disease response and the main imaging modality in most centers (particularly in North America).

Ultrasound is a non-invasive, readily available modality to assess the small bowel. It doesn't require oral contrast and avoids radiation. In the correct hands it can provide exquisite bowel wall and mucosal detail (better than CT or MR in some cases).1 Secondary features of hyperemia, fat wrapping allow subjective assessment of activity. Objective measurement of disease activity with CEUS is a developing area.2

Bowel ultrasound is a fantastic tool and skill for any radiologist to have in their armoury for the assessment of IBD. 

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