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    Your diagnosis?

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      History:
      A 5 year old boy presented in the emergency room because of persistent abdominal pain for 5 days with one episode of vomiting.
      Initially, the clinical picture was that of a nonspecific mesenteric lymphadenitis. Labs demonstrated leukocytosis of 24.00 Gpt/l with deviation to the left. Platelet count was 434.00 Gpt/l and CRP was 34 mg/l. ESR was increased (10 mm/h) with mild hypoproteinemia. Urinalysis was normal except for a few epithelial cells and bacteria.
      Ultrasound demonstrated an inflammatory thickened small bowel wall with a cockade like structure in the right mid abdomen. This bowel wall thickening was also visible in the left mid and lower abdomen with increasing amount of free intraabdominal fluid during the hospital stay.
      A CT of the abdomen was performed with the indication of an inflammatory pseudotumor, DD Burkitt lymphoma and a subileus. The boy underwent a diagnostic laparotomy and resection of a purple and thickened jejunal loop with end to end anastomosis.

      Radiological findings:

      Ultrasound 1 :: View Ultrasound 1 in Toolbox ::
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      Ultrasound 1:
      Wall thickened, hypervascular small bowel loop in the axial plane.





      CT 1 :: View CT 1 in Toolbox ::
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      CT 1:
      Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





      CT 2 :: View CT 2 in Toolbox ::
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      CT 2:
      Significantly wall thickened segment of jejunum in the left lower and mid abdomen with diffuse surrounding inflammatory reaction, lymphadenopathy and ascites.





      OP-Situs 1 :: View OP-Situs 1 in Toolbox ::
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      OP-Situs 1:
      Inflammatory changes and purple coloration of a small bowel loop, presenting as pseudotumor.





      Histology 1 :: View Histology 1 in Toolbox ::
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      Histology 1:
      Hemorrhagic necrotising enteritis with leukocytoclastic vasculitis.




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