Hello. Some help would be appreciated.
10 year old, MN, DSH. Presented with history of weight loss, lethargy, diarrhea, dehydration of short duration. Blood tests show neutropenia with a left shift but all else ok. Ultrasound examination abnormalities as follows:
* Enlarged sublumbar, colic, and mesenteric lymph nodes ranging from 2mm to 4.6mm
* Thickened small bowel that retains layering – some segments have thickened mucosal layer, some have thickened submucosal layer
* Urinary bladder: floating hyperechoic particles
Hello. Some help would be appreciated.
10 year old, MN, DSH. Presented with history of weight loss, lethargy, diarrhea, dehydration of short duration. Blood tests show neutropenia with a left shift but all else ok. Ultrasound examination abnormalities as follows:
* Enlarged sublumbar, colic, and mesenteric lymph nodes ranging from 2mm to 4.6mm
* Thickened small bowel that retains layering – some segments have thickened mucosal layer, some have thickened submucosal layer
* Urinary bladder: floating hyperechoic particles
* Spleen: diffuse mottled appearance, normal thickness.
I have already recommened surgical biopsy for a definitive diagnosis but was wondering if this is more along the lines of lymphoma rather than IBD. Thank you in advance.
Comments
Not clear cut as these US
Not clear cut as these US findings can be from both severe IBD and lymphoma. As the serum albumin is normal, would lean towards IBD rather than lymphoma as hypoalbuminemia is more indicative of lymphoma than IBD. Could try FNA of the lymph nodes prior to biopsy.
Thanks! These little hints
Thanks! These little hints are really helpful.
Sonogrpahically always
Sonogrpahically always examine the consistency of the submucosal layer. This is the structural holding layer and is key histopathologically in the interpretation of lsa vs ibd. In lsa the submucosal layer is disrupted by the lymphoid component and we can follow the curvilinear disruption of this layer sonographically. The echogenic submucosal layer is thick on your images but not disrupted. This fits IBD more than lsa. i would love to do a study on this and the deisgn is done for it but just no time to implement. There are instnaces where the submicosal layer is disrupted and not neoplastic so beware always need histpopath but the tendency i describe will help your interpretation
Check out our intraoperative us abstract from 10 years ago that evidences this change.
ECVIM Porto 2009
https://sonopath.com/educationevents/research-publications