D. Weber (Uniklinik Leipzig)  

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8 Years  

Female  

Other  

other  

8 year-old girl with a 3 week history of diarrhea, weight loss of about 2 kg and reoccurring stomach aches.  

Immunological with genetic determination.

Gliadine/Gluten induced morphological changes of the small intestinal mucosal membranes with atrophy of the villi.

Clinic: malabsorption

Begin of illness is mostly in the 6th - 18th month of live, but it can also occur later. Which factors contribute to the clinical manifestation is still unclear.

Increased rate for lymphomas.  

<- view Ultrasound 1

Ultrasound 1: Widened fluid-distended intestinal loops in the left middle abdominal region with increased peristalsis (red arrow), but without wall-thickening (yellow arrow).




<- view Ultrasound 2

Ultrasound 2: Widened fluid-distended intestinal loops in the left middle abdominal region with increased peristalsis, but without wall-thickening. Minimal free fluid (red arrow).




<- view Ultrasound 3

Ultrasound 3: Multiple mesenterial lymph nodes (green arrows) reaching up to 19x12mm in size without hyperperfusion.




<- view Ultrasound 4

Ultrasound 4: In the initial examination, "bulls-eye" is seen in the left middle abdominal region (light blue arrow), without acute clinical signs. Apparently, this is a small intestinal invagination, which is, in the follow-up exam not seen anymore.

 

Surgery / Histo  

Mesenterial lymphadenitis, enteritis  

Although all sonographic findings are unspecific, there are some that are often found in children with celiac disease:

- slightly dilated small intestinal loops
- slight, diffuse intestinal wall thickening
- increased peristalsis
- slightly enlarged mesenterial lymph nodes
- slight widened superior mesenteric artery (increased perfusion)
- slight widened superior mesenteric vein
- free fluid
- increased echogenicity of the liver

Gluten-free diet lessens the clinical symptoms. A life-long diet is needed.  

The ultrasound findings are unspecific. It is not uncommon, however, to find unspecific changes in children with celiac disease!

Do the mesenterial lymph-nodes always belong to the clinical picture?  

N/A  

1. Medline:
Rettenbacher T, Hollerweger A, Macheiner P, Huber S, Gritzmann N.
Adult celiac disease: US signs.
Radiology. 1999 May;211(2):389-94

2. Medline:
Riccabona M, Rossipal E.
Value of ultrasound in diagnosis of celiac disease
Ultraschall Med. 1996 Feb;17(1):31-3.

3. Medline:
Dietrich CF, Brunner V, Seifert H, Schreiber-Dietrich D, Caspary WF, Lembcke B.
Intestinal B-mode sonography in patients with endemic sprue. Intestinal sonography in endemic sprue
Ultraschall Med. 1999 Dec;20(6):242-7.
 

celiac disease, glutenenteropathy, nontropical sprue, invagination, mesenterial, mesentery, gluten, gliadin, enteritis, celiac, disease, child, childhood, pediatric radiology  

D Weber. Celiac disease. PedRad [serial online] vol 4, no. 2.
URL: www.PedRad.info/?search=20040207222335