Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

QUIZ
Year
: 2003  |  Volume : 13  |  Issue : 3  |  Page : 331--332

Radiological quiz - gastrointestinal radiology


K Taori, S Bhomne, N Ghonge, R Mundhada, A Rewatkar 
 Govt.Medical College, Nagpur, India

Correspondence Address:
K Taori
Dept of radiodiagnosis, Govt Medical College, Nagpur
India




How to cite this article:
Taori K, Bhomne S, Ghonge N, Mundhada R, Rewatkar A. Radiological quiz - gastrointestinal radiology.Indian J Radiol Imaging 2003;13:331-332


How to cite this URL:
Taori K, Bhomne S, Ghonge N, Mundhada R, Rewatkar A. Radiological quiz - gastrointestinal radiology. Indian J Radiol Imaging [serial online] 2003 [cited 2021 Jan 21 ];13:331-332
Available from: https://www.ijri.org/text.asp?2003/13/3/331/30479


Full Text

A 55 year old farmer presented to hospital with the complaints of swelling in right lower abdomen since 15 days, diarrhea with abdominal cramps, mild fever, fatigue, anorexia with constipation since 7 days. No blood in stools. Clinical examination suggested intra-abdominal hard, tender lump in right iliac fossa and lumbar region. This patient had similar complaints 6 months back which relieved with medical management. Double contrast Barium enema [Figure 1], Plain and Contrast CT Abdomen [Figure 2],[Figure 3] was performed.

 View Answer

 Radiological Diagnosis



 Intestinal Ameboma



 Discussion



Double Contrast Barium enema study [Figure 1] showed irregular; long segment narrowing with edematous and thickened mucosa with multiple ulcerations and spiking involving the caecum and ascending colon. CT abdomen plain and contrast study [Figure 2],[Figure 3] revealed mildly enhancing, long segment, circumferential, thickening of caecum and ascending colon in right lumbar region extending upwards upto the level of hepatic flexure causing significant luminal compromise. Ultrasonography study showed heterogeneous mass lesion in right lumbar region with 'pseudo kidney' appearance with long segment bowel wall thickening.

These imaging findings may mimic malignancy, but if we carefully review the clinical details, the patient had similar complaints and lump; six months back which relieved with medical management, the imaging features may be explained with an infective cause rather than neoplastic. The long segment involvement is also less common in malignancy. Colonoscopic biopsy was performed in this patient which showed amebic tropozoites and further confirmation attended with pas staining.

Patient was treated with metronidazole 750 mg tds and Diloxonide furoate 500 mg tds. Patient showed significant clinical improvement, lump regressed in size, and over a period of 15 days no lump was palpable & follow up USG did not reveale any bowel wall thickening.

Amebic colitis is caused by the protozoan Entameba histolytica. In the endemic areas as high as 20% of the population harbors this infection and only few will develop invasive amebiasis, in which the entameba releases a cytolytic enzyme and invades the bowel wall [1]. The radiological features of invasive amebiasis [2] includes a segmental or diffuse colitis, with a granular or ulcerated mucosa, apthoid ulceration, mucosal edema, haustral blunting, multiple strictures and ameboma formation occurs in about 10 % of cases [1]. Ameboma is a focal lesion, which manifest as an intraluminal mass, an annular lesion, irregular thickening of bowel wall with lack of normal distensibilitry, all signs may mimic a neoplasm with an apple core lesion [4]. It is more common in the right colon. Rapid disappearance of the lesion with appropriate antiamebic therapy is seen, which may help in confirming the diagnosis [3].

Hepatic amebiasis is the commonest extrainstestinal complication seen in about 15% of cases [1]. Caecal amebiasis may be complicated by appendicitis, and amebiasis anywhere in the colon may give rise to toxic colon [1]. It is essential to examine fresh stool for tropozoites in all patients with colitis, to exclude amebiasis. If there is a reasonable doubt of an amebic infection, the patient should be treated for amebiasis before surgery, and the 'malignancy' often then changes or even disappears [4].

So, before reporting large bowel malignancy the lesions mimicking malignancy and thorough clinical history and examination should be considered.

References

1Ronald G. Grainger, David Allison. Diagnostic Radiology: A textbook of medical imaging, Churchill Livingstone, third edition, vol-2: 1037-1038.
2Cardoso J M , Kimura K, Stoopen M et al 1977 Radiology of invasive amebiasis of the colon. Radiology 128: 935-941.
3David Sutton, textbook of radiology And imaging, Churchill Livingstone, sixth edition, vol-2: 893.
4Margulus and Bruhenne's Alimentary Tract radiology,5th edition , Vol-1: 915-918.