Just 2 images that i got today during 2 patients scanned.
Img 1)GUCCI 6yo FN JRT, with chronic diarrhea. Does the mucosa layer presents hypo and hyperechoic areas? in a layering pattern? (is this what is called pseudolayering?) and is this large intestine? (it looked like that to me) but was 0.43cm in thickness.
Just 2 images that i got today during 2 patients scanned.
Img 1)GUCCI 6yo FN JRT, with chronic diarrhea. Does the mucosa layer presents hypo and hyperechoic areas? in a layering pattern? (is this what is called pseudolayering?) and is this large intestine? (it looked like that to me) but was 0.43cm in thickness.
Img2. TESSA 12yo FN DSH with chronic weight loss and lymphadenomegaly. Is the muscularis the thickened one on this image? Is this a common finding on IBD cases, instead of the mucosa layer? any other differentials to include?
Thanks Veronica
Comments
Hi Dr. Damian,
Yes in the
Hi Dr. Damian,
Yes in the image on Tessa the muscularis is the outer, dark and in this case very thickened layer. In my experience and many others, the muscularis layer should be 1/3 or less the thickness of the mucosa. when the mucosa/muscularis ratio approaches 1:1, either IBD (severe) or lymphoma should be considered. Of course there is no sure way to know without doing at least FNA, or full thickness biopsy. Another indication is the loss of layering but sometimes that is not seen.
On Gucci, the image actually looks like small intestine with an enteritis pattern. Thick hyperechoic mucosa with almost normal mucsularis.
You can search for IBD on the clinical search and the case number 04_00132 Andy S is a great example of lymphoma with the changes above (looks a lot like the Tessa case but with ascites).
Just my two cents. 🙂 Hope this helps in a technical sense. Keep up the good scanning!
Tomie
Hi Dr. Damian,
Yes in the
Hi Dr. Damian,
Yes in the image on Tessa the muscularis is the outer, dark and in this case very thickened layer. In my experience and many others, the muscularis layer should be 1/3 or less the thickness of the mucosa. when the mucosa/muscularis ratio approaches 1:1, either IBD (severe) or lymphoma should be considered. Of course there is no sure way to know without doing at least FNA, or full thickness biopsy. Another indication is the loss of layering but sometimes that is not seen.
On Gucci, the image actually looks like small intestine with an enteritis pattern. Thick hyperechoic mucosa with almost normal mucsularis.
You can search for IBD on the clinical search and the case number 04_00132 Andy S is a great example of lymphoma with the changes above (looks a lot like the Tessa case but with ascites).
Just my two cents. 🙂 Hope this helps in a technical sense. Keep up the good scanning!
Tomie
With these findings and the
With these findings and the history of chronic diarrhea, I would be highly suspicious of IBD with emerging lymphoma as a differential diagnosis. To confirm the diagnosis full thickness biopsies are most likely required but could attempt endoscopically obtained ones. Also consider ruling out intestinal parasites by fecal analysis.
With these findings and the
With these findings and the history of chronic diarrhea, I would be highly suspicious of IBD with emerging lymphoma as a differential diagnosis. To confirm the diagnosis full thickness biopsies are most likely required but could attempt endoscopically obtained ones. Also consider ruling out intestinal parasites by fecal analysis.
Research is underway
Research is underway regarding increased muscularis/mucosal ratios as opposed to overall thickness. Whenthe muscularis approaches 1:1 this is of concern and is an optimal use for intraoperative US to delineate the lesion to bx surgically because the surgeon wont see what we see.
Click here for articles and see ecvim 2009.
I get more concerned with detail loss especially when the submucosal layer gets ragged and fuzzy and ill defined that is demonstrated in the downloadable poster on the iop us link above.
Main diffs here are likely ibd with potential for emerging lsa, mct, and dry form fip.
Keep dry form fip in the back of your mind to those triad cases that are not responding.
Click here and check out april and january 2011 COM for examples of this loss of detail to look for.
Research is underwayResearch is underway regarding increased muscularis/mucosal ratios as opposed to overall thickness. Whenthe muscularis approaches 1:1 this is of concern and is an optimal use for intraoperative US to delineate the lesion to bx surgically because the surgeon wont see what we see.
I get more concerned with detail loss especially when the submucosal layer gets ragged and fuzzy and ill defined that is demonstrated in the downloadable poster on the iop us link above.
Main diffs here are likely ibd with potential for emerging lsa, mct, and dry form fip.
Keep dry form fip in the back of your mind to those triad cases that are not responding.
Click here and check out april and january 2011 COM for examples of this loss of detail to look for.
Thank you so much for all
Thank you so much for all your comments, intestinal biopsy has been recommended, so fingers crossed that the owners accept and we can get an answer! Great differentials! and also the dry FIP, I’ll keep it in my mind 🙂
What are your key clues for performing intraoperative us on intestine? e.g. the sterile gel, do you apply it directly in the gut? how do you cover your probe? (we usually use a sterile glove when we do percutaneous tru-cut biopsies) do you use a special cover? if so what is the name?, how do you make sure you get a good image when you scan so close to the organ? (e.g. do you use a pad?, linear probe?,etc.)
Thank you so much for all
Thank you so much for all your comments, intestinal biopsy has been recommended, so fingers crossed that the owners accept and we can get an answer! Great differentials! and also the dry FIP, I’ll keep it in my mind 🙂
What are your key clues for performing intraoperative us on intestine? e.g. the sterile gel, do you apply it directly in the gut? how do you cover your probe? (we usually use a sterile glove when we do percutaneous tru-cut biopsies) do you use a special cover? if so what is the name?, how do you make sure you get a good image when you scan so close to the organ? (e.g. do you use a pad?, linear probe?,etc.)
Sorry Eric, I went back to
Sorry Eric, I went back to the article you wrote on intraoperative lesions and I found most of the answers there! Do you cover the probe cord with something? or just the probe head with the dobule layer of gloves? Thanks
Sorry Eric, I went back to
Sorry Eric, I went back to the article you wrote on intraoperative lesions and I found most of the answers there! Do you cover the probe cord with something? or just the probe head with the dobule layer of gloves? Thanks
There are commercial probe
There are commercial probe covers but i just put gel in a sx glove and double it up. Use saline on the intestine or ringers as a coupling agent.
There are commercial probe
There are commercial probe covers but i just put gel in a sx glove and double it up. Use saline on the intestine or ringers as a coupling agent.
You can also download the
You can also download the poster there on the link and it has a photo of the procedure.
You can also download the
You can also download the poster there on the link and it has a photo of the procedure.