Crohn's Disease... or not? The intestinal "Great Mimicker"

Congress:

ECR 2018

Poster Number:

C-0352

Type:

Educational Exhibit

Keywords:

Inflammation, Education and training, Diagnostic procedure, Gastrointestinal tract, Abdomen, MR-Enterography, CT-Enterography, Mesentery

Authors:

M. C. Terranova, D. Picone, F. Vernuccio, C. Tudisca, L. Scopelliti, A. Vinci, F. Midiri, G. Lo Re, R. Lagalla; Palermo/IT

DOI:

10.1594/ecr2018/C-0352

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0352

Fig. 1: Female 24 y.o.: Suspected CD. Post-operative histological diagnosis:...

Fig. 2: Male 29 y.o.: Ileitis by Yersinia

Fig. 3: Male 48 y.o.: TBC-related ileitis.

Fig. 4: Male 49 y.o.: Intestinal Lymphoma

Learning objectives

The aim of this poster is to describe the ancilary findings that can help in avoiding Crohn's Disease (CD) misdiagnosis of other medical and surgical entities with similar radiological appearance.

Background

Crohn’s disease is an idiopathic granulomatous inflammation of the gut which can commonly affect the terminal ileum, but, both clinically and radiologically it may mimic different medical entities, which must be taken into account when CD is suspected, especially since they may require different management and therapies.

Findings and procedure details

INFECTIOUS COLITIS [3]: - Yersinia: it causes thickened and nodular mucosal pattern of the terminal ileum, but rarely it presents as transmural involvement with fistula formation and fibrotic stenosis reliquiae, which, instead, may often be encountered in CD. - Salmonella: it shows circumferential and homogenous thickening of the terminal ileum, thus leading to a very easy CD misdiagnosis, and only biochemical and clinical investigation may solve the diagnostic dilemma. - Tuberculosis: although exclusively intestinal involvement is a relative rare condition, it is characterized byasymmetric wall...

Conclusion

The differential diagnosis is of paramount importance, since misdiagnosis may result in critical delays or errors in management, so astrong clinical-radiological and pathological cooperation is mandatory.

Personal information

Maria Chiara Terranova [email protected] Affiliation: University hospital policlinico P.Giaccone Via del Vespro 127, 90127 Palermo, Italy

References

1. Bojic D et Al. "Terminal ileitis is not always Crohn’s disease". Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology. 2011;24(4):271-275. 2. Horton KM et Al. "CT evaluation of the colon: inflammatory disease." Radiographics 20.2 (2000): 399-418. 3. DiLauro S et Al. "Ileitis: When It Is Not Crohn’s Disease". Current gastroenterology reports. 2010;12(4):249-258.