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Journal of Ultrasound in Medicine, Vol 13, Issue 10 751-756, Copyright © 1994 by American Institute of Ultrasound in Medicine
Gastrointestinal inflammation in children: color Doppler ultrasonography
S. P. Quillin and M. J. Siegel
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
We conducted this study to determine if color Doppler ultrasonography can
identify increased vascularity associated with gastrointestinal
inflammatory conditions and to determine if specific diagnoses can be
established based on flow patterns. Twenty-five children with acute right
lower quadrant pain and discharge diagnoses of inflammatory bowel processes
were examined by color Doppler sonography, as an adjunct to routine
gray-scale examinations. Final diagnoses included gastroenteritis (10
cases), Crohn's disease (five cases), neutropenic colitis (four cases),
peritonitis (four cases), and Yersinia enterocolitis (two cases). The
results of color Doppler sonography were considered positive for
inflammation if increased vascularity was demonstrated in the bowel mucosa,
muscularis layer, or adjacent tissues. A control group of 19 patients was
examined. No sonographic abnormalities were identified in any patients in
the control group. Diffuse, concentric wall thickening with increased blood
flow centrally within the mucosa was seen in Crohn's disease (60%) and
Yersinia enterocolitis (100%), whereas wall thickening with increased
transmural vascularity was identified in neutropenic colitis (50%) and
Crohn's disease (40%). In contrast, in peritonitis color Doppler sonography
showed thickened bowel wall and hypervascularity within peripheral bowel
wall or in adjacent soft tissues. No demonstrable bowel vascularity was
seen in gastroenteritis. Our experience suggests that mucosal or transmural
hypervascularity on color Doppler sonography can be seen with several
inflammatory bowel processes, but it is nonspecific. However, color Doppler
sonography may aid in differentiating primary bowel disease from extrinsic
inflammatory conditions, such as peritonitis.
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