Although these findings were consistent with a working diagnosis of Crohn’s disease, repeat colonoscopy was still planned, when the patient was more stable, to obtain histological evidence to support a definitive diagnosis.įigure 2. The terminal ileum had several mildly narrowed segments with minimally increased enhancement without wall thickening, and mesenteric lymphadenopathy was present. The patient’s MR enterography showed numerous thickened hyperenhancing segments of small bowel ( Figures 1, 2). It should be noted that normal imaging results alone do not sufficiently exclude a diagnosis of Crohn’s disease. CT and MRI can also detect extraintestinal manifestations and complications of Crohn’s disease (eg sacroiliitis, fistulae and abscesses). 2 In addition, MR imaging (MRI) can also identify ulcerations, increased mesenteric vascularity (comb sign), mesenteric inflammation and reactive adenopathy. These features are considered good indicators of clinically active disease. Suggested investigations with the results for this case Results for this patient are shown in Table 1. Non-radiological investigations to be considered include: chronic infectious causes (eg tuberculosis and human immunodeficiency virus infection).acute infectious causes (these are unlikely).malignancy (eg lymphoma, colorectal cancer, pancreatic carcinoma).The main differential diagnoses to consider are: What non-radiological investigations should be considered? Answer 1Ī history of chronic diarrhoea with weight loss and nocturnal symptoms is suggestive of an organic cause. What are the differential diagnoses? Question 2 The abdominal examination was unremarkable. He was an ex-smoker and denied current alcohol use.Ībnormal findings on examination were cachexia, hypotension, reduced air entry in both lung bases and moderate bilateral peripheral oedema. His current medications reflected these conditions. His past medical history included chronic obstructive pulmonary disease (COPD), gout, paroxysmal atrial fibrillation, biventricular failure, aneurysmal dilatation of the ascending aorta, chronic renal failure, hypertension, previous excess alcohol intake and previous endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. A man, aged 69 years, presented with a 2-year history of diarrhoea, including nocturnal symptoms, faecal incontinence, abdominal pain and weight loss of 22 kg.
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