Catherine
Moderator
- Joined
- Jan 30, 2012
- Messages
- 3,912
Hi Everyone
Received pathology request form and copies of two mri in the mail today.
GI has requested MCP, TGN, ESR, CRP.
I believe MCP, TGN are query dose of aza.
Sarah still has not symptoms and remains on 30mg pred.
Why is are GI and her second opinion from the Alfred Hospital saying this MRI result is "odd". GI is reviewing with the radiologist and will then discuss again with the Alfred GI.
MRI of 8th November 2012
Clinical Notes
Findings: There is a series of thick-walled small bowel loops in the central lower pelvis. The bowel wall thickening is not as pronounced as it was on the previous MRI dated January 30, 2012. The terminal ileum is relatively spared, with this process involving small bowel loops just proximal to this.
The thickened small bowel is T2 isointense. demonstrating relatively homogenous gradual progressive enhancement. The mesenteric fat is indurated and contracted. In amongst this inflamed contracted mesenteric tissue, there is the suggestion of multiple small fistulous tracts.
Previously, affected small bowel loops demonstrated a greater of bowel wall thickening but less in the way of mesenteric contraction and no definite fistulae were present.
Proximally, small bowel loops are not distended,weighting against a functionally significant obstruction.
No colonic abnormality shown.
Uterus and ovaries are normal. There is no significant free fluid.
Comment: There is evidence of ongoing inflammatory change involving distal ileal loops, relatively sparing the 5-10 of ileum.
In the interval, there has been progressive contraction of the inflamed mesentery with what appear to be a small fistulae.
MRI - 30 January 2012 - Does any why they are saying this is a interesting case?
Report: I presume the clinical notes represent a typographical error and the suspected pathology is Crohn disease rather than coeliac disease.
Confirmed circumfernetial wall thickening and abnormal enhancement of the pelvic ileal bowel loops extending into and involving the terminal ileum. This abnormality corresponds to the bowel wall thickening seen on recent ultrasound and is certainly consistent with inflammatory bowel disease (Crohn disease).
No other specific small bowel abnormality is detected. The jejumum and more proximal ileum are normal. There is no dilation of these bowel loops to indicate a mechanical obstruction. I do note a small amount of free intraperitioneal fluid especially in the pelvis adjacent to the thickened bowel loops.
Conclusion: Definite circumferential wall thickening and abnormal enhancement involving pelvic ileal loops extending up to and involving the terminal ileum. Appearances are certainly consistent with inflammatory bowel disease. Minor free fluid in the pelvis.
No other obvious complication. There is certainlyno evidence to suggest mechanical obstruction. Clincial follow up in this interesting case would be appreciated.
I hate waiting. The GI is saying that Sarah disease is both better and worse. Any help understanding these reports would be much appreciated.
Received pathology request form and copies of two mri in the mail today.
GI has requested MCP, TGN, ESR, CRP.
I believe MCP, TGN are query dose of aza.
Sarah still has not symptoms and remains on 30mg pred.
Why is are GI and her second opinion from the Alfred Hospital saying this MRI result is "odd". GI is reviewing with the radiologist and will then discuss again with the Alfred GI.
MRI of 8th November 2012
Clinical Notes
Findings: There is a series of thick-walled small bowel loops in the central lower pelvis. The bowel wall thickening is not as pronounced as it was on the previous MRI dated January 30, 2012. The terminal ileum is relatively spared, with this process involving small bowel loops just proximal to this.
The thickened small bowel is T2 isointense. demonstrating relatively homogenous gradual progressive enhancement. The mesenteric fat is indurated and contracted. In amongst this inflamed contracted mesenteric tissue, there is the suggestion of multiple small fistulous tracts.
Previously, affected small bowel loops demonstrated a greater of bowel wall thickening but less in the way of mesenteric contraction and no definite fistulae were present.
Proximally, small bowel loops are not distended,weighting against a functionally significant obstruction.
No colonic abnormality shown.
Uterus and ovaries are normal. There is no significant free fluid.
Comment: There is evidence of ongoing inflammatory change involving distal ileal loops, relatively sparing the 5-10 of ileum.
In the interval, there has been progressive contraction of the inflamed mesentery with what appear to be a small fistulae.
MRI - 30 January 2012 - Does any why they are saying this is a interesting case?
Report: I presume the clinical notes represent a typographical error and the suspected pathology is Crohn disease rather than coeliac disease.
Confirmed circumfernetial wall thickening and abnormal enhancement of the pelvic ileal bowel loops extending into and involving the terminal ileum. This abnormality corresponds to the bowel wall thickening seen on recent ultrasound and is certainly consistent with inflammatory bowel disease (Crohn disease).
No other specific small bowel abnormality is detected. The jejumum and more proximal ileum are normal. There is no dilation of these bowel loops to indicate a mechanical obstruction. I do note a small amount of free intraperitioneal fluid especially in the pelvis adjacent to the thickened bowel loops.
Conclusion: Definite circumferential wall thickening and abnormal enhancement involving pelvic ileal loops extending up to and involving the terminal ileum. Appearances are certainly consistent with inflammatory bowel disease. Minor free fluid in the pelvis.
No other obvious complication. There is certainlyno evidence to suggest mechanical obstruction. Clincial follow up in this interesting case would be appreciated.
I hate waiting. The GI is saying that Sarah disease is both better and worse. Any help understanding these reports would be much appreciated.
