CT and MRI of Rare Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents

Abstract

Inflammatory bowel disease (IBD) is associated with a spectrum of extraintestinal manifestations (EIMs) affecting many organ systems. EIMs can occur in more than 40% of patients with IBD and are associated with significant morbidity. They occur at any time point in the course of disease, often during an active phase of bowel inflammation, but sometimes preceding bowel disease. Prompt recognition of EIMs enables timely and more effective therapy. Physicians who image patients with IBD should be aware of the myriad extraintestinal conditions that may be detected on imaging studies, both within and outside of the abdomen, as they may predate the diagnosis of IBD. Cross-sectional imaging of unusual conditions associated with IBD will be presented, including pathology in the hepatobiliary, pancreatic, genitourinary, musculoskeletal, mucocutaneous, vascular, neurologic, and pulmonary systems.

Inflammatory bowel disease: Looking beyond the tract

“…EIMs are estimated to affect approximately 6% to 47% of adult patients with IBD and around 25% to 29% of pediatric patients with IBD. 4,5 They have been reported to occur more frequently in patients with CD compared with those with UC. 5 A patient may be affected by several EIMs at the same time, given that the presence of one EIM increases the likelihood of developing another.…”

“…4,5 They have been reported to occur more frequently in patients with CD compared with those with UC. 5 A patient may be affected by several EIMs at the same time, given that the presence of one EIM increases the likelihood of developing another. 4 A Swiss IBD cohort study showed that 25% of patients with IBD affected by EIMs actually suffered from multiple, in some cases up to five different EIMs.…”

“…Both usually respond to drainage and antibiotics, with sterile abscesses also responding to corticosteroids. 5…”

“…4 The diagnosis of axial arthropathies is made clinically and supported by imagining. 5 Magnetic resonance imaging (MRI) is the current gold standard since it can detect acute and chronic changes before radiographs show any abnormalities, therefore, resulting in earlier disease detection. 18…”

“…Both usually respond to drainage and antibiotics, with sterile abscesses also responding to corticosteroids. 5 In general, medications that have been found to be associated with hepatotoxicity comprise of thiopurines, methotrexate, sulfasalazine, cyclosporine, and biologic agents. 43 Specific drugs that might play a role in the development of non-alcoholic fatty liver disease (NAFLD), which, along with non-alcoholic steatohepatitis (NASH), affect approximately 9.4% of patients with UC and 19.3% of patients with CD, include corticosteroids, methotrexate, and azathioprine.…”