Case Of the Week (COW) 09 June 2013
Answer:
Crohn's disease with enteropathic arthritis.
Findings:
The ascending colon shows submucosal fat with prominent vasarecta giving comb sign appearance. Multiple subcentimeter sized mesenteric nodes noted in ileocaecal region. Minimal thickening and narrowing of terminal ileum seen. Surgical clips noted in GB fossa suggestive of post cholecystectomy status. Severe fatty liver seen. Diffuse osteopenia noted in spine with marginal syndesmophytes, calcification of interspinous and ligamentum flavum and fusion of facet joints. Sacroiliac joints appear fused bilaterally.
Discussion:
Features are suggestive of acute on chronic crohn’s disease with chronic activity shown as submucosal fat in ascending colon and acute activity as prominent vasarecta[comb sign] and minimal ileal thickening with mesentric nodes inileocaecal region. Extraintestinal manifestations like fattyliver, cholecystectomy for gall stones, enteropathic arthropathy which mimics ankylosing spondylosis and osteoporosis are noted.
Contributed By:
Dr. Ramesh D(ortho), MDRD, Dr. Iyappan PonnuswamyMDRD, FRCR, Dr. Susila Krishnan DMRD, DNB
Kauvery Hospital, Chennai
Answer:
Crohn's disease with enteropathic arthritis.
Findings:
The ascending colon shows submucosal fat with prominent vasarecta giving comb sign appearance. Multiple subcentimeter sized mesenteric nodes noted in ileocaecal region. Minimal thickening and narrowing of terminal ileum seen. Surgical clips noted in GB fossa suggestive of post cholecystectomy status. Severe fatty liver seen. Diffuse osteopenia noted in spine with marginal syndesmophytes, calcification of interspinous and ligamentum flavum and fusion of facet joints. Sacroiliac joints appear fused bilaterally.
Discussion:
Features are suggestive of acute on chronic crohn’s disease with chronic activity shown as submucosal fat in ascending colon and acute activity as prominent vasarecta[comb sign] and minimal ileal thickening with mesentric nodes inileocaecal region. Extraintestinal manifestations like fattyliver, cholecystectomy for gall stones, enteropathic arthropathy which mimics ankylosing spondylosis and osteoporosis are noted.
Contributed By:
Dr. Ramesh D(ortho), MDRD, Dr. Iyappan PonnuswamyMDRD, FRCR, Dr. Susila Krishnan DMRD, DNB
Kauvery Hospital, Chennai