Wk 5, Case 5 - Review

EXAM: MRI Small Bowel without and with IV Contrast

INDICATION: 9-year-old female with several weeks of abdominal pain.

TECHNIQUE: MR imaging was performed utilizing multiple pulse sequences both before and after the administration of IV contrast.

FINDINGS:

The lung bases appear unremarkable.

The liver is normal in size and contour. There are no cystic or solid intrahepatic lesions identified. The gallbladder is unremarkable without signs of acute cholecystitis. Negative for intrahepatic or hepatic biliary ductal dilations. Negative for calculi.

The spleen and pancreas are unremarkable in appearance.

The kidneys are normal in size and appearance bilaterally. Negative for hydronephrosis or gross urolithiasis. The bladder is fluid-filled but otherwise unremarkable.

There are no dilated loops of small or large bowel to suggest obstruction. There is moderate to large stool burden within the entire colon, as well as the rectum. There is a ~5 cm segment of distal ileum with wall thickening up to the terminal ileum and additional hyperenhancement and adjacent mesenteric fat stranding. There are several loops of small bowel that are not fluid filled and therefore these are limited in evaluation. The remainder of the large and small bowel is unremarkable in appearance. Negative for stricture, ulceration, or fistulization.

The abdominal wall is unremarkable. The abdominal aorta is normal in course and caliber. The IVC and portal venous vasculature are unremarkable. There are scattered enlarged right lower quadrant lymph nodes which are likely reactive in nature.

There is trace intra-abdominal free fluid visualized predominantly within the right lower quadrant. Negative for pneumoperitoneum. Negative for acute bony abnormalities.

IMPRESSIONS:

1. 5 cm segment of terminal ileum with bowel wall thickening and hyperenhancement, as well as mesenteric fat stranding, consistent with active inflammatory bowel disease. Negative for stricture or fistula.
2. Trace right lower quadrant ascites and scattered enlarged mesenteric lymph nodes, likely reactive.
3. Moderate to large stool burden throughout the colon and rectum.