CT results question: "mural thickening and fatty infiltration"

[syzygy]

I'm hoping I can get some help on interpreting CT results. The report boils down to the following impression: "Mural thickening and fatty infiltration of the terminal ileum [consistent with CD]. No evidence of active inflammation at this time. No evidence of bowel obstruction."

Given that there's no inflammation (which there was in September prior to starting Remicade), what does that mural inflammation and fatty infiltration mean? The radiologist doesn't use the term stricture anywhere in this report, but I'm wondering if that's what he's getting at.

Background: I had the scan yesterday to check on things, because since starting Remicade 3.5 weeks ago, I've had nonstop diarrhea and bloating, which are not typical day-to-day symptoms for me. The general course of my illness has been symptom-free most of the time with sporadic episodes of small bowel obstruction that generally resolve on their own.

I have a call in to the GI doc, but am feeling kind of anxious to puzzle this out. Can anyone help me understand these results? Thanks.

 

[DJW]

I wish I could help but I don't know.

 

[syzygy]

I've gotten the message elsewhere that the mural thickening and lack of inflammation are not consistent statements in radiologist-speak. I'm going to have a radiologist I know personally take a second look at the images. My GI doc wants to take a peek via colonoscopy.

 

[BuzzyBee]

I'm hoping I can get some help on interpreting CT results. The report boils down to the following impression: "Mural thickening and fatty infiltration of the terminal ileum [consistent with CD]. No evidence of active inflammation at this time. No evidence of bowel obstruction."

Mural thickening means the bowel wall is thicker than normal. Fatty infiltration (often referred to as "fat halo") is where fatty deposits leak through an abraded section of the mucosa (the hairy lining of the bowel) and spread out behind the mucosa, around the leaky area. And, yes, it's indicative of Crohn's disease.

Given that there's no inflammation (which there was in September prior to starting Remicade), what does that mural inflammation and fatty infiltration mean? The radiologist doesn't use the term stricture anywhere in this report, but I'm wondering if that's what he's getting at.

Fatty infiltration doesn't necessarily cause a stricture. The radiologist is explaining that the fat halo is there but there is no inflammation. If there were, then you would have a stricture there. For now, it is just a bulge toward the bowel wall. Your GE doctor would probably view it as a potential site for inflammation.

My first surgery, in 2013, was to be a strictoplasty to remove just such a site, which had been repeatedly inflamed for 2 or 3 years. A colonsoscopy was done after the CT, where a small polyp was sighted at the site where the halo had appeared on the scan. It was sampled (benign). I was watching all that on the screen. The stricture was almost total. That is, it had inflamed and healed repeatedly until the ileum was full of scar tissue.

When the surgeon got in there, he found a whole bunch of diverticuale near that stricture, in the small bowel, that had fistulated together, so he had to do an anastomosis instead, removing not just the lesion but a hearty chunk of small bowel and the ileal colon. It was an elective surgery but pretty urgent, so I didn't have to wait long. It went smoothly and I was home after four days.