Paediatric Crohn's disease: a radiological review

Abstract

Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close cooperation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution.

Ultrasound scanning may reduce the need for barium radiology in the assessment of small‐bowel Crohn's disease

“…USS is useful as a non-invasive tool to assess ileal disease activity with excellent positive predictive value, but has low negative predictive value. When there is clinical suspicion of active small-bowel disease when USS is negative or when stricture formation is suspected, further investigations are indicated (11). The data presented in this series should be tested with a prospective evaluation of the use of BaFT and USS in the assessment of children with clinically active CD.…”

The accordion sign at CT: report of a case of Crohn's disease with diffuse colonic involvement

“…Crohn's disease is a chronic inflammatory disease that affects the entire digestive tract from the oral mucosa to the anal verge [4,7]. Apart from clinical and laboratory data and conventional barium studies, CT is an established tool in the diagnosis of the disease, its complications, and in the differential diagnosis among other inflammatory diseases of the bowel [4,5,6,7], sometimes contributing to management decisions.…”

“…Apart from clinical and laboratory data and conventional barium studies, CT is an established tool in the diagnosis of the disease, its complications, and in the differential diagnosis among other inflammatory diseases of the bowel [4,5,6,7], sometimes contributing to management decisions. The CT signs of Crohn's disease are well defined in the literature [4,6,7] and include mural thickening of the involved bowel, mucosal edema presenting as the ªdouble haloº sign, fibrofatty proliferation of the mesentery (the ªcreeping fatº sign), enteric fistulas, mesenteric lymph node enlargement, mesenteric phlegmon, and abscess.…”

The smaller bowel: imaging the small bowel in paediatric Crohn's disease

“…The SBFT depicts characteristic features of CD including fissures, cobblestone mucosa, pseudopolyps (inflammatory polyps), and skip lesions, which themselves are very suggestive of CD (figures 1 and 2). Early findings on SBFT include fold thickening, distortion, and blunting as a result of submucosal inflammation 13. Wall thickening is usually eccentric and on the mesenteric side with pseudodiverticulum formation on the antimesenteric side.…”