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How do you tell the differences between Crohn’s disease and other types of bowel diseases? What makes you call Crohn’s over others? Also, how do you tell the differences between enteric duplication cyst and GIST? They look so similar except for the vasc? With the bowel wall being >5mm, does this criteria only apply to terminal ileitis? Or can I use this bowel wall thickening (>5mm) criteria to diagnose any bowel pathology? Thanks Stephen!
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Howdy,
I cannot tell the difference between Chris’s disease and other inflammatory bowel conditions on ultrasound alone. My typical worksheet will say something like: “No abnormality was seen in the abdominal visceral organs. A detailed assessment of the area where the patient is experiencing pain demonstrates a segment of bowel with changes of inflammatory bowel disease. This includes bowel wall thickening, increased echogenicity of adjacent mental fat and increased vascularity. Onward referral for gastroentirologist opinion is recommended”.If it is the terminal ilium, then Crohn’s disease is on the top of my list, but if it in the sigmoid colon I put diverticulitis at the top of the list.
Ultrasound in my hands is not specific and the CT scan may show a cancer where I suspected inflammatory disease etc. But I feel like I have made a great difference to the patient by noticing the inflammatory changes in the bowel and sending them down the correct pathway of investigation even if I can’t give a definitive diagnosis.
Yes I am happy to use 5mm for all bowel walls.Enteric duplication cysts are truly cystic, where as GIST is a solid mass. The duplication cyst will not be vascular and the GIST will be vascular with Doppler assessment.
Duplication cysts demonstrate a “double wall sign”
They also have a “muscular rim sign” with an inner hyperechoic mucosa / submucosa and an outer hypoechoic surrounding of muscularis propria.This is different from a GIST appearance.
Steve
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