Non-Crohn Ileitis in MSCT- enterography (MSCT-e) and in MR-enterography (MR-e) : a review of 15-years of clinical application in a referred centre for GASTRO-INTESTINAL pathology

Congress:

ECR 2019

Poster Number:

C-1839

Type:

Educational Exhibit

Keywords:

Diagnostic procedure, MR-Enterography, CT-Enterography, Gastrointestinal tract, Abdomen, Inflammation, Pathology

Authors:

R. Faraone, C. Gozzo, F. Lionti, M. C. Terranova, A. Crapanzano, M. T. Anzelmo, S. Salerno, G. Lo Re; Palermo/IT

DOI:

10.26044/ecr2019/C-1839

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1839

Fig. 1: Male 29 y.o. Ileitis by Yersinia

Fig. 2: Female 40 y.o. Intestinal Lynphoma

Fig. 3: Female 26 y.o. Eosinophilic Gastroenteritis

Learning objectives

We reviewed a single centre 15 years experience of MSCT- e and MR-e application in detection of non-Crohn ileitis (nCl) describing misdiagnosis of other medical and surgical entities with similar radiological appearance.

Background

Ileitis is an inflammation of the ileum that can occur with different patterns of clinical presentation, from an acute and self-limited form to some conditions with chronic and debilitating course. It is often caused by Crohn's disease (CD) but it can also deal with other many pathological entities nCl. CD and nCI can both present themselves with a similar clinical and radiological pattern so the correct diagnosis is important to choice the right patients management.

Findings and procedure details

NCI can be divided into infectious colitis, vasculitis, bowel ischemia, radiation enteritis, drug-related enteritis, endometriosis, eosinophilic gastroenteritis, ileitis associated with spondyloarthropathies. NCI show non specific CT-E and MR-E findings such as bowel-wall thickening, obstruction or ascites. Differential diagnosis can be done observing specific radiological signs and clinical correlations (concomitant reactive arthritis) or patients associated treatment (drugs or radiation therapy). Enhancement CT may detect mesenteric vessels engorgement and abnormal bowel-wall enhancement in case of vasculitis. Bowel ischemia may present altered enhancement and submucosal oedema. We can...

Conclusion

Knowing CT-E and RM-E differential finding of NCI is of paramount importance because misdiagnosis may result in critical delays or errors in management. The clinical disease course, imaging and pathological cooperation are essential to get a good diagnosis.

Personal information

Roberta Faraone [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.