Diagnostic ultrasound ( PDFDrive )

CHAPTER 8 The Gastrointestinal Tract 275
A B C
D E F
G H I
FIG. 8.20 Strictures in Three Patients With Crohn Disease. (A) An axial view of the terminal ileum shows wall thickening and surrounding
inlammatory fat. (B) The long-axis image shows long segment thickening with luminal apposition. (C) Conirmatory luoroscopic image from a
small bowel enema shows the long, tight stricture in the ileum. (D) and (E) Sonograms of the terminal ileum show an abrupt transition in the
caliber of the gut (arrow). The gut proximal to the arrow is dilated and luid illed. The distal gut has a stricture, conirmed on (F), the small bowel
enema. (G) Short-axis image through the stricture shows the thickened wall and surrounding inlamed fat. (H) Long-axis image of the neoterminal
ileum shows a thickened, featureless wall with a caliber alteration (arrows). (I) Conirmatory CT scan.
(Fig. 8.22, Video 8.11). Spiking of the border of acutely inlamed
gut is characteristic (see Fig. 8.14). On occasion, an air-containing
tract may be identiied, traversing the bowel wall into the
perienteric fat. Phlegmonous masses should alert the sonographer
to possible underlying localized perforation.
Inlammatory Masses
Inlammatory masses involving the ibrofatty mesentery are the
most common complication of Crohn disease, although the
development of abscesses with drainable pus occurs infrequently.
Before the stage of liquefaction, phlegmonous change may be
noted as poorly deined, hypoechoic areas without luid content
interdigitating into the surrounding inlamed fat (Figs. 8.23A
and B and 8.24A). Abscess formation results in a complex or
luid-illed mass (Figs. 8.23G-I and 8.24B). Gas content within an
abscess is helpful in suggesting an abscess, but this gas content
is also a potential source of sonographic error, particularly if
large quantities are present. Abscesses may be intraperitoneal
or extraperitoneal or may be in remote locations such as the
liver, abdominal wall (Fig. 8.23H and I), and psoas muscles.
An excellent application of CEUS is in the characterization of
inlammatory masses related to the bowel in a variety of clinical
situations. he diferentiation of phlegmonous inlammatory
masses, without drainable pus, from those with liquid content