Ultrasound diagnosis of typhlitis

Abstract

Purpose Typhlitis, also known as neutropenic colitis, is a rare inflammatory condition and a potentially life-threatening disease process that typically involves the cecum. Delay in diagnosis may lead to a fatal prognosis with a death rate of 21-48%. Ultrasound evaluation of right lower quadrant may lead to an accurate and rapid diagnosis. Methods We describe the case of a 59-year-old female with advanced Churg-Strauss syndrome treated with cyclophosphamide, with acute right lower quadrant pain. Results Ultrasound was the first diagnostic step in the diagnosis of typhlitis. Sonographic findings were comparable to CT imaging. Conclusions Bowel bedside ultrasound evaluation in emergency settings may lead to a prompt and definitive diagnosis. Although CT is considered the gold standard in the diagnosis and staging of neutropenic colitis, ultrasound was able to identify the pathology accurately. Ultrasound findings of typhlitis are highly characteristic, showing circumferential wall thickening with predominant submucosa. Keywords Bedside ultrasound • Typhlitis • Bedside • Acute colitis • Emergency ultrasound SOMMARIO La tiflite, nota anche come colite neutropenica, è una rara forma di colite infiammatoria potenzialmente mortale (21-48%) che coinvolge il cieco, correlata ad alta mortalità se diagnosticata tardivamente. La tipica sintomatologia e localizzazione a livello cecale, rendono la valutazione ecografica e la conoscenza della patologia fondamentale, consentendo una diagnosi differenziale rapida ed efficace. Descriviamo il caso di una donna di 59 anni affetta da sindrome di Churg Strauss, in trattamento con ciclofosfamide che presentava dolore addominale localizzato al quadrante inferiore destro. L'ecografia della fossa iliaca destra ha dimostrato un quadro caratteristico e sovrapponibile ai reperti TC, con presenza di ispessimento e stratificazione parietale del ceco e dell'ultima ansa con prevalenza della sottomucosa. L'esame ecografico dell'intestino in emergenza è in grado di diagnosticare rapidamente ed efficacemente molte patologie intestinali acute, consentendo di differenziare tra patologie chirurgiche non chirurgiche. Nel caso della colite neutropenica, anche se La TC è ancora considerata il gold standard diagnostico, l'esame ecografico può identificare correttamente il quadro patologico ed essere una valido strumento diagnostico per il monitoraggio. I segni ecografici di tifilite sono estremamente caratteristici mostrando un incremento di spessore di parete circonferenziale con prevalenza ed iperecogenicità della sottomucosa.

Typhlitis: A Rare Appendicitis Mimic in a Young Healthy Female

“…Our patient had a typical presentation and compatible CT findings; notably, identification of cecitis despite leukocytosis led to conservative versus operative management as well as diagnosis of typhlitis. Ultrasound is typically the first radiologic evaluation for this presentation as it is a faster modality with high sensitivity for appendicitis and typhlitis [7], but considering further characterization of bowel inflammation on CT has been recommended when it does not significantly delay diagnosis. Bowel wall thickening and inflammation of the cecum detected by CT have been proposed as the main criterion to establish the diagnosis of typhlitis [2,4,5,[7][8][9].…”

“…Ultrasound is typically the first radiologic evaluation for this presentation as it is a faster modality with high sensitivity for appendicitis and typhlitis [ 7 ], but considering further characterization of bowel inflammation on CT has been recommended when it does not significantly delay diagnosis. Bowel wall thickening and inflammation of the cecum detected by CT have been proposed as the main criterion to establish the diagnosis of typhlitis [ 2 , 4 , 5 , 7 - 9 ]. The extent of bowel wall thickening is also a valuable prognostic factor, which adversely affects the outcome [ 9 ].…”

Combination of Common Problem in a Rare Disease: Right Iliac Fossa Pain in a Chronic Myeloid Leukemia Patient

“…Ultrasonography is generally regarded as a first-line diagnostic test in acute appendicitis and has shown to have a sensitivity and specificity of 86% and 81% respectively [ 12 ]. In typhlitis, the US has reportedly been used with good yield, identifying certain features that may point towards the diagnosis, such as; absent or decreased bowel peristalsis in the RLQ, thickened hypoechoic bowel wall, and markedly thickened echogenic mucosa producing a target or halo sign [ 13 - 14 ]. CT abdomen may reveal more information and help to differentiate between the two diagnoses with more accuracy and is considered the gold standard [ 15 ].…”

Ultrasound of Small Bowel Obstruction: A Pictorial Review

“…Although ultrasound allows us to identify the five concentric layers of the intestinal loops, this evaluation is not applied in the diagnosis of SBO. In practice, the evaluation is limited to the presence or absence of parietal stratification (two-layer double halo sign or three-layer target sign) ( Figure 4 a–d and Figure 5 a,b) [ 29 , 35 , 42 ].…”