Gastrointestinal Imaging Cases (Cases In Radiol...
Henoch-Schonlein purpura (HSP) is a small vessel vasculitis mediated by type III hypersensitivity with deposition of IgA immune complex in the walls of vessels. It is a multi-system disorder characterized by palpable purpura, arthritis, glomerulonephritis and gastrointestinal manifestations and commonly occurs in children and young adults. The patients with gastrointestinal involvement usually present with colicky abdominal pain, vomiting and melena. The imaging findings include multifocal bowel thickening with mucosal hyperenhancement, presence of skip areas, mesenteric vascular engorgement, with involvement of unusual sites like stomach, duodenum and rectum. These imaging findings in a child or young adult with appropriate clinical findings could suggest HSP.
Gastrointestinal Imaging Cases (Cases in Radiol...
processing.... Drugs & Diseases > Radiology Lower Gastrointestinal Bleeding Imaging Updated: Oct 18, 2021 Author: Marc D Haber, MD; Chief Editor: Kyung J Cho, MD, FACR, FSIR more...
Share Print Feedback Close Facebook Twitter LinkedIn WhatsApp Email webmd.ads2.defineAd(id: 'ads-pos-421-sfp',pos: 421); Sections Lower Gastrointestinal Bleeding Imaging Sections Lower Gastrointestinal Bleeding Imaging Practice Essentials Computed Tomography Magnetic Resonance Imaging Nuclear Imaging Angiography Show All Media Gallery References Practice Essentials Lower gastrointestinal bleeding is defined as bleeding from the bowel distal to the ligament of Treitz (see the image below). Lower GI bleeding can be acute or chronic. Massive GI bleeding will result in hemodynamic instability and decreasing hemoglobin levels, which need to be treated with transfusions. Flexible endoscopy is the gold standard for the diagnosis and treatment of GI bleeding but identifies the bleeding in only up to 40% of cases. Once bleeding is identified on endoscopy, over 90% of cases can be successfully treated. Approximately 85% of cases of lower GI bleeding can be managed by supportive treatment only. [1, 2, 3, 4, 5] Diverticulosis has been implicated as the source of bleeding in as many as 60% of cases. The diverticula are more prevalent in the left or sigmoid colon, but positive arteriographic findings for bleeding localizes the bleeding to the right colon in 60% of cases. 
However, the 2 widely used diagnostic tests for lower GI bleeding are nuclear scanning (see the image above) during episodes of bleeding or angiography (see the images below). [19, 20] In cases in which colonoscopy is unsuccessful, scanning during episodes of bleeding and angiography are considered to be next imaging tests to determine the cause of the bleeding. Catheter-directed angiography remains the best option in a patient in unstable condition and should be performed in cases of massive bleeding. 
The imaging features of 42 histopathologically confirmed cases of Gastrointestinal Stromal Tumors (GIST) were analyzed, to observe the pattern of metastasis. At presentation 22 of 42 patients (52.3%) showed metastasis. During follow-up, three more cases developed metastasis, within one year of resection. Mesentery, omentum, and liver were the most frequent sites for metastasis. Other sites that were rarely reported to be involved were increasingly recognized to show metastasis due to longer survival. The metastasis often showed attenuation and enhancement characteristics, similar to primary GIST, and frequently showed necrosis, hemorrhage, and calcification.
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Interventional radiologists diagnose and treat disease. They treat a wide range of conditions in the body by inserting various small tools, such as catheters or wires from outside the body. X-ray and imaging techniques such as CT and ultrasound help guide the radiologist. Interventional radiology can be used instead of surgery for many conditions. In some cases, it can eliminate the need for hospitalization.
Bowel wall thickening may be focal and segmental or diffuse. In cases of focal thickening, the degree and symmetry of thickening and perienteric abnormalities help narrow the differential diagnosis: while heterogeneous and asymmetric focal thickening is usually associated with malignancies, symmetric regular and homogeneous thickening may be caused by benign conditions but also well-differentiated tumours. Disproportionate fat stranding compared to the degree of wall thickening suggests inflammatory conditions. Segmental or diffuse bowel thickenings are usually caused by benign conditions, with the exception of lymphoma. Common causes include ischaemia, inflammatory and infectious conditions. The pattern of attenuation helps narrow the differential diagnosis of segmental or diffuse wall thickening but still there is a significant overlap on CT imaging findings of different non-neoplastic bowel conditions.
X-ray technology is the oldest and most frequently used type of medical imaging, with a long tradition of maintaining safe levels of radiation exposure. Healthcare providers take care to use the lowest radiation dose possible and minimize stray radiation by carefully controlling X-ray beams. Only the body part under examination should be exposed. While frequent small doses of radiation could add up to greater risk, side effects from a typical stand-alone X-ray exam are rare. The risks of anesthesia and other more invasive procedures are greater. In most cases, the benefits of radiology far outweigh the risks. 041b061a72