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Magnetic resonance enterography: the test of choice in diagnosing intestinal "zebras".

Kumar AS, Coralic J, Vegeler R, Kolli K, Liang J, Estep A, Chudzinski AP, McFadden JD - Case Rep Gastrointest Med (2015)

Bottom Line: At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient.In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies.With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as "zebras."

View Article: PubMed Central - PubMed

Affiliation: Section of Colon and Rectal Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA ; Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.

ABSTRACT
Small bowel tumors and other rare intestinal disorders are often exceedingly difficult to identify. Even cutting-edge technologies, such as push enteroscopy and capsule endoscopy, can fail to determine the cause of a patient's symptoms. At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient. In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies. With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as "zebras."

No MeSH data available.


Related in: MedlinePlus

Axial MRE image showing mass in the small bowel mesentery and an enlarged lymph node (a) compared to an axial CT scan that only shows bowel wall thickening (b). Coronal MRE images with carcinoid tumor and an enlarged lymph node in the mesentery (c) and mass in the bowel wall (d).
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fig1: Axial MRE image showing mass in the small bowel mesentery and an enlarged lymph node (a) compared to an axial CT scan that only shows bowel wall thickening (b). Coronal MRE images with carcinoid tumor and an enlarged lymph node in the mesentery (c) and mass in the bowel wall (d).

Mentions: The patient had multiple repeat endoscopies at these separate institutions as well as a small bowel enteroscopy and CT and MRI scans in the weeks and months prior to the MRE. All of these tests were unable to uncover the etiology for the patient's symptoms. MRE was then pursued, revealing a mass in the small bowel mesentery that was consistent with a carcinoid tumor (Figure 1). The patient was able to proceed to the operating room four days later to have a laparotomy with a small bowel resection and an appendectomy. The finding at the time of surgery was a carcinoid tumor in the distal ileum with invasion into the mesentery.


Magnetic resonance enterography: the test of choice in diagnosing intestinal "zebras".

Kumar AS, Coralic J, Vegeler R, Kolli K, Liang J, Estep A, Chudzinski AP, McFadden JD - Case Rep Gastrointest Med (2015)

Axial MRE image showing mass in the small bowel mesentery and an enlarged lymph node (a) compared to an axial CT scan that only shows bowel wall thickening (b). Coronal MRE images with carcinoid tumor and an enlarged lymph node in the mesentery (c) and mass in the bowel wall (d).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321082&req=5

fig1: Axial MRE image showing mass in the small bowel mesentery and an enlarged lymph node (a) compared to an axial CT scan that only shows bowel wall thickening (b). Coronal MRE images with carcinoid tumor and an enlarged lymph node in the mesentery (c) and mass in the bowel wall (d).
Mentions: The patient had multiple repeat endoscopies at these separate institutions as well as a small bowel enteroscopy and CT and MRI scans in the weeks and months prior to the MRE. All of these tests were unable to uncover the etiology for the patient's symptoms. MRE was then pursued, revealing a mass in the small bowel mesentery that was consistent with a carcinoid tumor (Figure 1). The patient was able to proceed to the operating room four days later to have a laparotomy with a small bowel resection and an appendectomy. The finding at the time of surgery was a carcinoid tumor in the distal ileum with invasion into the mesentery.

Bottom Line: At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient.In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies.With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as "zebras."

View Article: PubMed Central - PubMed

Affiliation: Section of Colon and Rectal Surgery, Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA ; Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.

ABSTRACT
Small bowel tumors and other rare intestinal disorders are often exceedingly difficult to identify. Even cutting-edge technologies, such as push enteroscopy and capsule endoscopy, can fail to determine the cause of a patient's symptoms. At our institution magnetic resonance enterography (MRE) has become an increasingly reliable tool in the difficult-to-diagnose or difficult-to-monitor patient. In this retrospective case series, we discuss four patients with four rare intestinal disorders that were successfully diagnosed using MRE after failing to be diagnosed using more routine technologies, such as CT scans and flexible sigmoidoscopies. With the discussion of these four cases we demonstrate that MRE is a useful diagnostic modality in patients whose surveillance is difficult or to diagnose rare colorectal disease phenomena, colloquially referred to as "zebras."

No MeSH data available.


Related in: MedlinePlus