Hospital: Hospital Universitario la Paz.
Ciudad:
Nº:
Aut@r o Autores: P. Carreño Moran, S. Yañez Castaño, D. Vargas Jimenez, P. Arias Rodriguez, A. Sanchez Martin, J. Uzcategui Leon. CAUSA Complejo Asistencial Salamanca,,
Presentación:
73 years hepatic transplantation, constitutional syndrome and immunosuppressive therapy. Colonoscopy: ulcerated lesion in cecum. Abdominopelvic TC: diffuse and segmentary symmetric thickening in wall cecum and ileal loops, low attenuation adenopathy and patchy airspace opacities in the right upper lobes.?
Discusión:
DIFERENCIAL DIAGNOSIS ALGORITHMIC: SPECTRUM OF FIVEATTENUATION PATTERNS OBSERVED IN BOWEL WALL DISEASE: 1. Bowell wall thickening. a) focal 40cm suggest Benign, (except lymphoma 3 patterns: aneurismatic dilated wall, polypoid o adenopathy’s). 2. Pattern of attenuation: -White: ischemia or active inflammatory bowel disease (IBD). Avid contrast material enhancement that uniformly affects the majority of the thickened bowel wall. Suggest 2 pathologies: (a) vasodilation and/or (b) injury to intramural vessels with accompanying interstitial leakage. “Shock bowel” diffuse ischemia of the small bowel in hypotensive adults who have sustained blunt trauma) white attenuation pattern represents a reversible ischemic. -Gray: ischemia, chronic IBD o radiation enteritis (RE) Stratified: ischemia/vasculitis, active IBD, infection, RE, portal hypertension – Black: pneumatosis ischemic (portal o vein gas), infection o benign. – Water halo: stratification within a thickened bowel wall that consists of either 2 o 3 (“target sign”: ) continuous, symmetrically thickened layers. Halo sign with two layers (double halo) is composed of either a higher-attenuation outer annular ring surrounding a second, is most valuable as an unequivocal observation of bowel wall injury, often of an acute nature. Infections, IBD, vascular disease o RE – The pattern of the fat halo sign refers to a three-layered target sign of thickened bowel in which the middle or “submucosal” layer has a fatty attenuation (<10UH) : colitis ulcerosa, RE .Diferencial diagnosis: – Mycobacteria’s – Sarcoidosis – Lymphoma
Conclusión:
DIFERENCIAL DIAGNOSIS ALGORITHMIC: SPECTRUM OF FIVEATTENUATION PATTERNS OBSERVED IN BOWEL WALL DISEASE: 1. Bowell wall thickening. a) focal 40cm suggest Benign, (except lymphoma 3 patterns: aneurismatic dilated wall, polypoid o adenopathy’s). 2. Pattern of attenuation: -White: ischemia or active inflammatory bowel disease (IBD). Avid contrast material enhancement that uniformly affects the majority of the thickened bowel wall. Suggest 2 pathologies: (a) vasodilation and/or (b) injury to intramural vessels with accompanying interstitial leakage. “Shock bowel” diffuse ischemia of the small bowel in hypotensive adults who have sustained blunt trauma) white attenuation pattern represents a reversible ischemic. -Gray: ischemia, chronic IBD o radiation enteritis (RE) Stratified: ischemia/vasculitis, active IBD, infection, RE, portal hypertension – Black: pneumatosis ischemic (portal o vein gas), infection o benign. – Water halo: stratification within a thickened bowel wall that consists of either 2 o 3 (“target sign”: ) continuous, symmetrically thickened layers. Halo sign with two layers (double halo) is composed of either a higher-attenuation outer annular ring surrounding a second, is most valuable as an unequivocal observation of bowel wall injury, often of an acute nature. Infections, IBD, vascular disease o RE – The pattern of the fat halo sign refers to a three-layered target sign of thickened bowel in which the middle or “submucosal” layer has a fatty attenuation (<10UH) : colitis ulcerosa, RE .Diferencial diagnosis: – Mycobacteria’s – Sarcoidosis – Lymphoma
Bibliografía:
– Sugi MD, Menias CO, Lubner MG, Bhalla S, Mellnick VM, Kwon MH, Katz DS. CT Findings of Acute Small-Bowell Entities. Radiographics. 2018 , 38: 13521369. – Fernandes T, Oliveira MI, Castro R, Araújo B, Viamonte B, Cunha R. Bowel wall thickening at